A Pre-Post Trial Evaluating the Supporting Transitions and Empowering Preferences (STEP) Decision Support Intervention for Long-Term Care Residents Facing Hospital Transfer Decisions During Acute Health Crises
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 200
- 试验地点
- 2
- 主要终点
- Decisional Conflict
研究概览
简要总结
This trial will evaluate whether the Supporting Transitions and Empowering Preferences (STEP) toolkit can improve decision-making about hospital transfers in long-term care residents and their substitute decision-makers and enhance decision self-efficacy in nursing staff.
The trial will answer the questions:
- Does the STEP tool reduce decisional conflict in residents and care partners at the time of transfer decisions?
- Does it improve nurse self-efficacy related to hospital transfer decisions?
Participants will:
- Use the STEP tool during key moments of care planning (admission, care conferences, and acute events)
- Complete a short survey measuring their decisional conflict
- Be supported by trained nurses who use STEP to guide hospital transfer discussions
Researchers will compare data collected before and after the STEP tool is implemented at two long-term care homes to see if it improves shared decision-making related to hospital transfers by reducing decisional conflict.
详细描述
Background and Rationale: Transitions from long-term care (LTC) to hospital are complex and can offer both benefits and challenges to residents and care partners. While LTC-to-hospital transitions can improve health outcomes, particularly during acute deterioration, evidence also indicates that these transitions may disrupt continuity of care, increase stress, and misalign resident needs with hospital protocols. Nearly fifty percent of LTC residents in Canada experience hospital transitions annually, with approximately forty percent considered avoidable. Risks include non-evidence-based care, safety concerns, unnecessary interventions, and increased mortality rates. Transition decisions are influenced by residents' health status, medico-legal concerns, staff workload, and care partners' confidence in LTC care. These decisions are often reactive and shaped by unequal power dynamics rather than proactive, collaborative planning.
Given these challenges, and limitations in current monitoring systems such as the Minimum Data Set assessments, there is a critical need for a decision aid that supports informed, resident-centered planning. The Supporting Transitions and Empowering Preferences (STEP) tool was developed through interviews, co-design sessions, document analysis, and stakeholder engagement.
Objectives Primary Objective: Evaluate the impact of STEP on decisional conflict among residents and care partners.
Secondary Objective: Examine the effect of STEP on nurses' self-efficacy as decision coaches at the time of transition decisions.
Trial Design and Study Setting: A pre-post evaluation will be conducted at two LTC sites (Perley Health and Bruyère Health Saint-Louis LTC) to assess STEP's ability to support resident-care partner dyads in making hospital transition decisions. STEP will be implemented simultaneously at both sites.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 55 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Residents-care partner dyads:
- •Must be residents of either Perley Health or Bruyère Health Saint-Louis LTC home.
- •Residents must be 55 years of age or older.
- •Must be able to communicate in French or English.
- •Both members of the dyad will be included where applicable. For dyads in which residents do not have the capacity to participate, inclusion will occur through the involvement of their substitute decision-maker (e.g., power of attorney for personal care).
- •Must be a nurse, nurse practitioner, social service worker or physician actively involved in care planning, annual conferences, or managing acute health events at Perley Health or Bruyère Health.
- •Must have been employed at the LTC home for at least 6 months to ensure familiarity with the care environment and residents.
- •Must play a role in facilitating discussions, providing clinical input (where applicable), or guiding decision-making processes related to hospital transitions or acute care management.
- •Must be able to communicate in French or English.
排除标准
- 未提供
研究组 & 干预措施
STEP Intervention
Participants (resident-care partner dyads) in this arm will receive the STEP intervention. STEP is a decision aid designed to support shared decision-making about whether to transfer to hospital or remain in LTC during acute health events. It includes an educational booklet, a structured decision aid, and a staff phone script used at three points in the resident's care journey: (1) upon LTC admission, (2) during annual care conferences, and (3) at the time of an acute medical event. LTC nurses will receive training to deliver the STEP tool and support residents and care partners in making informed, values-based transition decisions.
干预措施: STEP Decision Support Toolkit (Behavioral)
结局指标
主要结局
Decisional Conflict
时间窗: Administered by Research Assistant 1-6 weeks after a transition decision.
Measured using the Decisional Conflict Scale (16 items; each rated on a 5-point scale; standardized total score 0-100, with higher scores indicating greater decisional conflict and worse decision-making outcomes).
次要结局
- Resident Health Outcomes Post-Transition(Measured continuously during the 6 months pre-intervention and 6 months post-intervention periods.)
- Decision Self-Efficacy(Administered by Research Assistant 1-6 weeks after a transition decision and periodically thereafter.)
- Transition Rate(Measured continuously during the 6 months pre-intervention and 6 months post-intervention periods.)