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This program did not improve residents\u2019 comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Pre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous 4 months. The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying\u2013End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At baseline, we included 177 residents with advanced dementia, 126 with non-advanced dementia and 156 without dementia. Post-intervention, respectively in the control and the intervention group, we included 136 and 104 residents with advanced dementia, 167 and 110 with non-advanced dementia and 157 and 137 without dementia. We found no subgroup differences on comfort in the last week of life, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1;\n                      <jats:italic>p<\/jats:italic>\n                      -value\u2009=\u20090.177), non-advanced versus without dementia (2.7;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u20090.092), and advanced versus non-advanced dementia (\u2212\u20090.6;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u20090.698); or on quality of care and dying in the last month of life, comparing advanced and without dementia (\u2212\u20090.6;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u20090.741), non-advanced and without dementia (\u2212\u20091.5;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u20090.428), and advanced and non-advanced dementia (0.9;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u20090.632).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The lack of subgroup difference suggests that while the program did not improve comfort in dying residents with or without dementia, it appeared to equally improve quality of care and dying in the last month of life for residents with dementia (regardless of the stage) and those without dementia. A generalist and non-disease-specific palliative care program, such as PACE Steps to Success, is a useful starting point for future palliative care improvement in nursing homes, but to effectively improve residents\u2019 comfort, this program needs further development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      ISRCTN,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.isrctn.com\/ISRCTN14741671\">ISRCTN14741671<\/jats:ext-link>\n                      . Registered 8 July 2015 \u2013 Retrospectively registered.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12904-021-00734-1","type":"journal-article","created":{"date-parts":[[2021,3,7]],"date-time":"2021-03-07T04:02:27Z","timestamp":1615089747000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["No difference in effects of \u2018PACE steps to success\u2019 palliative care program for nursing home residents with and without dementia: a pre-planned subgroup analysis of the seven-country PACE trial"],"prefix":"10.1186","volume":"20","author":[{"name":"on behalf of PACE","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6580-6548","authenticated-orcid":false,"given":"Rose","family":"Miranda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tinne","family":"Smets","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nele","family":"Van Den Noortgate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny T.","family":"van der Steen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc","family":"Deliens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"Payne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Szczerbi\u0144ska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Pautex","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liesbeth","family":"Van Humbeeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Gambassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marika","family":"Kyl\u00e4nen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lieve","family":"Van den Block","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,7]]},"reference":[{"key":"734_CR1","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1007\/s00038-012-0394-5","volume":"58","author":"JB Broad","year":"2013","unstructured":"Broad JB, Gott M, Kim H, et al. 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Belgium: Commissie Medische Ethiek UZBrussel, 27\/05\/2015; England: NHS \u2013 NRES Committee North West-Haydock, 10\/09\/2015; Finland: Terveyden jahyvinvoinnin laitos, Institutet f\u00f6r h\u00e4lsa och v\u00e4lf\u00e4rd, 30\/6\/2015; Italy: Comitato Etico, Universita Cattolica del Sacro Cuore, 6\/11\/2017; Netherlands: Medisch Ethische Toetsingscommissie VUMedisch Centrum, 2\/7\/2015; Poland: Komisja Bioetycza, Uniwersytetu Jagiellonskiego, 25\/6\/2015; Switzerland: Commission cantonaled\u2019\u00e9thique de la recherch\u00e9 scientifique de Gen\u00e8ve (CCER), 6\/8\/2015. In accordance with national laws and guidelines, each partner involved in data collection developed a protocol for researchers in case adverse events occur in a participating nursing home. No adverse events were reported by researchers during the trial. All respondents gave prior informed consent in writing. In Poland and the Netherlands, informed consent was not required by the ethics committees based on the conditions for consent in both countries, as the questionnaires were filled in anonymously by the respondents.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that there is no conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"39"}}