Cluster Randomised Controlled Trial (CRCT)

Cluster Randomised Controlled Trial (CRCT) examining the effect of different models of facilitation when implementing the Gold Standards Framework in Care Homes programme facilitation of end of life care initiatives: Julie Kinley, Louisa Stone & Jo Hockley

This study commenced in 2009 and builds on the previous work of Hockley (2006) and Hockley (2010) which identified the importance of both ‘high facilitation’ and ‘action learning’ when implementing change in nursing care homes. The studies hypothesis was:

‘High facilitation’ when implementing the Gold Standards Framework in Care Homes (GSFCH) programme will result in a reduced proportion of hospital deaths for residents and improvement in the care home staff ability to facilitate good end of life care. What are the cost-benefits between different models of facilitation?

Julie Kinley

Julie Kinley

Twenty-four nursing care homes formed two intervention groups. Both of these groups received high facilitation as they implemented the GSFCH programme within their nursing care home whilst the managers of one group additionally received nine months of action learning. Fourteen nursing care homes acted as a third observational group and received the usual GSFCH facilitation available locally in their area.

There are two aspects of the research:

  • The CRCT which is focusing on ‘outcomes’
  • A ‘mixed methods’ study focusing on ‘process’

Data from the CRCT focusing on ‘outcomes’ is now complete

Data includes information collected from:

  • The files of 2444 deceased residents regarding their last six months of life: their place of death; hospital admissions; use of end of life care tools; hospital OPAs; A&E attendances; details of all professionals who assessed them and how many times; their use of equipment; and, the medication prescribed for them in their last month of life
  • Teamwork questionnaires from all members of staff within all 38 nursing homes pre/post implementation
  • Questionnaires to the residents bereaved relative’s

Mixed methods study focusing on ‘process’

This study has been undertaken within the same 38 nursing care homes but is looking at the ‘process’ of change and has six objectives:

  1. To understand current knowledge about implementation of new end of life care initiatives within  nursing care home practice
  2. To evaluate three models of facilitation that support the implementation of the GSFCH programme
  3. To describe the experience of those providing and those receiving these models of facilitation
  4. To identify the barriers and enablers to the implementation the GSFCH programme
  5. To identify if a relationship exists between outcomes of the GSFCH programme and the process of facilitation.
  6. To make recommendations for a future model of facilitation

Data collection is now complete and includes information collected from:

  • The managers from all participating nursing care homes at the start and at the end of the study (questionnaires)
  • The GSFCH coordinators in post at the end of the study (questionnaires)
  • The GSFCH facilitators during the study (kept a Facilitators Activity Log) and at the end of the study (interview)

Volunteers (below) have played a major role in helping to collect and upload data.  They were recruited through the general hospice volunteers by Julie Kinley (above right).

Care Homes volunteers

Care Homes volunteers

Posters & Presentations

Hockley, J Kinley, J.  Exploring how the MRC complex intervention framework explains the sequential practice-based research steps undertaken to develop end of life care in nursing homes. The 7th World Research Congress of the EAPC in Trondheim 7-9 June 2012.

Hockley, J & Kinley, J. The use of action learning sets to enhance facilitation of the Gold Standards Framework in Care Homes’ end of life care programme: the intervention arm of a cluster randomised control trial – 19th International Congress on Palliative Care Montreal October 2012.

Kinley J & Hockley J. Methodological challenges and opportunities when undertaking a cluster randomised controlled trial (CRCT) in nursing homes  (JK – EAPC Trondheim, Norway June 2012)

Kinley, J, Stewart R., McCrone P.,Dewey M., Stone, L. & Hockley, J. Improving Outcomes at the End of Life in Nursing Homes – A Cluster Randomised Controlled Trial. 19th International Congress on Palliative Care Montreal October 2012.

Kinley J, Froggatt K, Preston N. Following not missing the thread EAPC. Copenhagen May 2015

Kinley J, Froggatt K, Preston N. Multi-layered Learning – A Mechanism to Translate End of Life Policy into Practice Aural – Oral presentation – Copenhagen May 2015

Marsh L, Kinley J, Hockley J, Stone L, Murtagh FEM. What influences the transfer of nursing home residents to emergency departments; good planning, prescribing and primary care needed EAPC Copenhagen May 2015 – download poster (PDF)


Kinley J, Froggatt K & Bennett M (2012). The effect of policy on end-of-life care practice within nursing care homes: A systematic review.Palliative  Medicine  – published online 4 January.

Kinley J, Dewey M, Stewart R, McCrone P, Stone L, Begum A, Sykes N, Hansford P.& Hockley J. The effect of different models of facilitation when implementing the Gold Standards Framework in Care Homes programme: A Cluster Randomised Controlled Trial.   (Awaiting publication)


Ennis L., Kinley J., Hockley J. and McCone P. (2015) The cost of providing end of life care for nursing care home residents: A retrospective cohort study. Health Services Management Research. First published on October 27, 2015 doi: 10.1177/0951484815607541.

Kinley J., Hockley J., Stone L., Dewey M., Hansford P., Stewart R., McCrone P., Begum A. and Sykes N. (2013) The provision of care for residents dying in UK nursing care homes. Age and Ageing doi:10.1093/ageing/aft158.

Find out more downloads, contacts and useful links