Implementing, Evaluating, and Scaling Up of the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) Program
- Conditions
- Frail Elderly Syndrome
- Interventions
- Other: Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) Program
- Registration Number
- NCT03935997
- Lead Sponsor
- McMaster University
- Brief Summary
This study will evaluate the implementation of the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) program using a cross-jurisdictional, effectiveness-implementation type II hybrid design (dual testing of clinical and implementation interventions) to assess the implementation (feasibility, fidelity, reach, sustainability) and effectiveness (family satisfaction, staff knowledge and confidence implementing a palliative approach to care, hospital use).
- Detailed Description
The SPA-LTC program has been developed and refined through prior participatory action based studies.
Evidence-based components of the program include:
Palliative Champion Teams; Palliative Care Education, including illness-trajectory pamphlets for staff and family members; Comfort Care Rounds with staff; Prognostic Tools to trigger end-of-life discussions; Palliative Care Conferences; Bereavement Pamphlets for families; and Post-Bereavement Follow-Up for families, and staff
The goal is to implement and assess this program across three provinces in Canada (Ontario, Saskatchewan, Manitoba). The investigators will use the findings to revise the program and inform the scaling up of the program across diverse settings and provinces.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 594
- English-speaking LTC residents with a score of 50% or less on the Palliative Performance Scale.
- Non-English speaking LTC residents
- residents with a score of more than 50% on the Palliative Performance Scale.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) Program Within the intervention arm 9 long-term care homes will receive the SPA-LTC program:3 in Ontario; 3 in Saskatchewan and 3 in Manitoba.
- Primary Outcome Measures
Name Time Method Number of Emergency Department Visits in the Resident's Last Year of Life All residents in the home who died one year prior to the implementation and one year prior to the date of death for all residents in the home who die during the study intervention period.
- Secondary Outcome Measures
Name Time Method Number of Hospital Deaths during the trial Chart audit at start of the trial to capture data on residents who died in the year prior to the trial. Chart audits also during the transition phase prior to Steps 2 and 3; and one month after the intervention period for the trial ends. Chart data at each study site will be audited to capture data on the number of hospital deaths in the year prior to the trial and during the trial.
Chart data at each study site will be audited to capture data on the number of hospital transfers in the residents last year of life.Family Perceptions of End of Life Care Survey completed at enrolment into the study; survey completed 2 months after the Family Care Conference or 1 month after the end of the intervention period if no Family Care Conference occurred. Survey
Staff Knowledge about a Palliative Approach to Care All staff in all participating long-term care homes will complete a staff survey at 2 points in the study: at the beginning and the end of the intervention Survey
Number of Hospital Transfers per Resident Chart audit at start of the trial to capture data on residents who died in the year prior to the trial. Chart audits also during the transition phase prior to Steps 2 and 3; and one month after the intervention period for the trial ends. Chart data at each study site will be audited to capture data on the number of hospital transfers in the last year of life for residents who died 1 year before the trial or who die during the trial.
Family Experiences with End of Life Care Interview completed at enrolment into the study; survey completed 2 months after the Family Care Conference or 1 month after the end of the intervention period if no Family Care Conference occurred. Interview
Bereaved Family Satisfaction with End of Life Care 6 weeks to 2 months after the resident's death Qualitative interview with family members whose loved one died during the trial.
Resident Satisfaction with End of Life Care At the time of enrolment and 2 months after the Family Care Conference or 1 month after the intervention period if no Family Care Conference occurred. Qualitative interview with residents who are enrolled in the trial
Trial Locations
- Locations (4)
University of Regina
🇨🇦Regina, Saskatchewan, Canada
McMaster University
🇨🇦Hamilton, Ontario, Canada
University of Saskatchewan
🇨🇦Saskatoon, Saskatchewan, Canada
University of Manitoba
🇨🇦Winnipeg, Manitoba, Canada