# The influence of care home registration type and size on senior care leader’s confidence to provide palliative and end-of-life care: an explanatory sequential mixed methods study

## TL;DR

This study explores how the type and size of care homes affect leaders' confidence in providing palliative and end-of-life care.

## Contribution

It identifies specific factors like nursing availability and infrastructure that influence confidence in palliative care delivery.

## Key findings

- Nursing home leaders showed higher confidence in palliative care compared to residential home leaders.
- Three themes promoting confidence include preparedness, partnership working, and shared language from guidance.
- Training and multidisciplinary teamwork benefit all leaders, but mechanisms vary by care home type and size.

## Abstract

Care home staff are key providers of palliative and end-of-life care. Yet, little is known about how care home characteristics can influence care leader’s confidence in their ability to provide optimal palliative and end-of-life care.

To understand the influence of care home registration type (nursing, residential or dual registered) and size on senior care leader’s confidence to provide palliative and end-of-life care.

An explanatory sequential mixed methods study comprising an online cross-sectional survey (including the Palliative Care Self-Efficacy Scale) and qualitative individual interviews. Analysis of survey data used a multivariate logistic regression and qualitative interview data used Framework Analysis. A ‘Following the Thread’ method was undertaken for data integration.

UK care home senior care leaders, purposively sampled by registration type, size and geographical location.

The online survey (N = 107) results indicated that nursing home senior care leaders had higher confidence scores on the Palliative Care Self-Efficacy Scale than residential care home leaders (aOR: 3.85, 95% CI 1.20-12.31, p = 0.02). Care home size did not show effect when adjusting for registration type (medium - aOR 1.71, 95% CI 0.59–4.97, p = 0.33; large – aOR 0.65, 95% CI 0.18–2.30, p = 0.5). Interviews (n = 27) identified three themes that promote confidence, (1) ‘feelings of preparedness’ stemming from staff expertise and experience and care home infrastructure, (2) ‘partnership working’ with external services as a valued member of the multidisciplinary team, and (3) a shared language developed from end-of-life care guidance.

Care home senior care leader’s confidence is influenced by care home characteristics, particularly availability of on-site registered nurses and the infrastructure of large care homes. All care home leaders benefit from training, working with external, multidisciplinary teams and use of guidance. However, mechanisms to achieve this differed by care home type and size. Further exploration is needed on successful integration of palliative care services and interventions to enhance confidence in residential care homes.

The online version contains supplementary material available at 10.1186/s12904-024-01525-0.