OBJECTIVES The number of older people dying in long-term care facilities (LTCFs) is increasing globally, but care quality may be variable. A framework was developed drawing on empirical research findings from the Palliative Care for Older People (PACE) study and a scoping review of literature on the implementation of palliative care interventions in LTCFs. The PACE study mapped palliative care in LTCFs in Europe, evaluated quality of end-of-life care and quality of dying in a cross-sectional study of deceased residents of LTCFs in 6 countries, and undertook a cluster-randomized control trial that evaluated the impact of the PACE Steps to Success intervention in 7 countries. Working with the European Association for Palliative Care, a white paper was written that outlined recommendations for the implementation of interventions to improve palliative and end-of-life care for all older adults with serious illness, regardless of diagnosis, living in LTCFs. The goal of the article is to present these key domains and recommendations. DESIGN Transparent expert consultation. SETTING International experts in LTCFs. PARTICIPANTS Eighteen (of 20 invited) international experts from 15 countries participated in a 1-day face-to-face Transparent Expert Consultation (TEC) workshop in Bern, Switzerland, and 21 (of 28 invited) completed a follow-up online survey. METHODS The TEC study used (1) a face-to-face workshop to discuss a scoping review and initial recommendations and (2) an online survey. RESULTS Thirty recommendations about implementing palliative care for older people in LTCFs were refined during the TEC workshop and, of these, 20 were selected following the survey. These 20 recommendations cover domains at micro (within organizations), meso (across organizations), and macro (at national or regional) levels addressed in 3 phases: establishing conditions for action, embedding in everyday practice, and sustaining ongoing change. CONCLUSIONS AND IMPLICATIONS We developed a framework of 20 recommendations to guide implementation of improvements in palliative care in LTCFs.

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长期护理机构的姑息治疗实施：欧洲姑息治疗协会白皮书

目标 在全球范围内死于长期护理机构 (LTCF) 的老年人人数正在增加，但护理质量可能参差不齐。根据老年人姑息治疗 (PACE) 研究的实证研究结果和对在 LTCF 中实施姑息治疗干预的文献进行范围界定，制定了一个框架。PACE 研究描绘了欧洲 LTCFs 的姑息治疗，在 6 个国家 LTCFs 已故居民的横断面研究中评估了临终关怀的质量和死亡质量，并进行了一项整群随机对照试验，评估了PACE Steps to Success 干预对 7 个国家的影响。与欧洲姑息治疗协会合作，编写了一份白皮书，概述了实施干预措施的建议，以改善生活在 LTCF 中的所有患有严重疾病的老年人的姑息治疗和临终关怀，无论诊断如何。本文的目的是介绍这些关键领域和建议。设计透明的专家咨询。设置 LTCF 的国际专家。参与者 来自 15 个国家的 18 名（20 名受邀）国际专家参加了在瑞士伯尔尼举行的为期 1 天的面对面透明专家咨询 (TEC) 研讨会，21 名（28 名受邀）完成了后续在线调查。方法 TEC 研究使用 (1) 面对面研讨会来讨论范围审查和初步建议，以及 (2) 在线调查。结果 在 TEC 研讨会期间，对 LTCF 中老年人实施姑息治疗的 30 项建议进行了细化，其中 20 项是在调查后选出的。这 20 条建议涵盖了微观（组织内部）、中观（跨组织）和宏观（国家或地区）层面的领域，分 3 个阶段处理：建立行动条件、嵌入日常实践和维持持续变化。结论和启示 我们制定了一个包含 20 项建议的框架，以指导 LTCF 改善姑息治疗的实施。为行动创造条件，融入日常实践，并保持持续的变化。结论和启示 我们制定了一个包含 20 项建议的框架，以指导 LTCF 改善姑息治疗的实施。为行动创造条件，融入日常实践，并保持持续的变化。结论和启示 我们制定了一个包含 20 项建议的框架，以指导 LTCF 改善姑息治疗的实施。