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| Name | Class |
|---|---|
| Alberta Health services | OTHER |
| Hospice Palliative Care Ontario | UNKNOWN |
| Canadian Hospice Palliative Care Association | UNKNOWN |
| Canadian Virtual Hospice |
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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).
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention | Experimental | 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. |
|
| Control | No Intervention | Within the control arm 9 long-term care homes will receive the standard of care: 3 in Ontario; 3 in Saskatchewan and 3 in Manitoba. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) Program | Other | Our team will work with long-term care homes in the study to implement the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) which consists of the following core, evidence-informed components: Palliative Champion Teams (to provide leadership and support implementation); Palliative Care Education (including illness trajectory pamphlets); Comfort Care Rounds with staff (for capacity building and reflection); Prognostic Tools to trigger end-of-life discussions; Palliative Care Conferences with families and residents; Bereavement Pamphlets; and Post-Bereavement Follow-Up for families, and staff. |
| Measure | Description | Time Frame |
|---|---|---|
| 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Family Perceptions of End of Life Care | Survey | 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. |
| Family Experiences with End of Life Care |
| Measure | Description | Time Frame |
|---|---|---|
| Fidelity of the Intervention | Checklist | Checklist completed weekly during the intervention period for up to 160 weeks. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Sharon Kaasalainen, PhD | McMaster University, School of Nursing | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Manitoba | Winnipeg | Manitoba | Canada | |||
| McMaster University |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30583908 | Background | Sussman T, Kaasalainen S, Lee E, Akhtar-Danesh N, Strachan PH, Brazil K, Bonifas R, Bourgeois-Guerin V, Durivage P, Papaioannou A, Young L. Condition-Specific Pamphlets to Improve End-of-life Communication in Long-term Care: Staff Perceptions on Usability and Use. J Am Med Dir Assoc. 2019 Mar;20(3):262-267. doi: 10.1016/j.jamda.2018.11.009. Epub 2018 Dec 21. | |
| 30207512 |
| Label | URL |
|---|---|
| SPA-LTC webpage (housed on the Canadian Hospice Palliative Care Association website) | View source |
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There is no plan to make individual participant data (IPD) available to other researchers.
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| UNKNOWN |
| Saskatchewan Health Authority - Regina Area | OTHER |
| Interlake-Eastern Regional Health Authority | UNKNOWN |
Within each of the three provinces, six LTC homes will be randomly selected, and then randomly allocated using a 1:1 ratio, stratified according to province, to either the intervention or control group using a computer-generated list. For each province, three LTC homes will receive the intervention and three will receive usual care. A biostatistician not involved in recruitment will generate group assignments.
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There is no need to mask participants, clinicians or research staff.
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|
Interview |
| 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. |
| Staff Knowledge about a Palliative Approach to Care | Survey | 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 |
| Number of Hospital Transfers per Resident | 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. | 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. |
| Number of Hospital Deaths during the trial | 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. | 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. |
| Bereaved Family Satisfaction with End of Life Care | Qualitative interview with family members whose loved one died during the trial. | 6 weeks to 2 months after the resident's death |
| Resident Satisfaction with End of Life Care | Qualitative interview with residents who are enrolled in the trial | 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. |
| Hamilton |
| Ontario |
| Canada |
| University of Regina | Regina | Saskatchewan | Canada |
| University of Saskatchewan | Saskatoon | Saskatchewan | Canada |
| Thompson G, Shindruk C, Wickson-Griffiths A, Sussman T, Hunter P, McClement S, Chochinov H, McCleary L, Kaasalainen S, Venturato L. "Who would want to die like that?" Perspectives on dying alone in a long-term care setting. Death Stud. 2019;43(8):509-520. doi: 10.1080/07481187.2018.1491484. Epub 2018 Sep 12. |
| 29308424 | Background | Sussman T, Kaasalainen S, Bui M, Akhtar-Danesh N, Mintzberg S, Strachan P. "Now I Don't Have to Guess": Using Pamphlets to Encourage Residents and Families/Friends to Engage in Advance Care Planning in Long-Term Care. Gerontol Geriatr Med. 2017 Dec 20;3:2333721417747323. doi: 10.1177/2333721417747323. eCollection 2017 Jan-Dec. |
| 29284551 | Background | Durepos P, Kaasalainen S, Sussman T, Parker D, Brazil K, Mintzberg S, Te A. Family care conferences in long-term care: Exploring content and processes in end-of-life communication. Palliat Support Care. 2018 Oct;16(5):590-601. doi: 10.1017/S1478951517000773. Epub 2017 Dec 29. |
| 29271241 | Background | Kaasalainen S, Sussman T, Durepos P, McCleary L, Ploeg J, Thompson G; SPA-LTC Team. What Are Staff Perceptions About Their Current Use of Emergency Departments for Long-Term Care Residents at End of Life? Clin Nurs Res. 2019 Jul;28(6):692-707. doi: 10.1177/1054773817749125. Epub 2017 Dec 22. |
| ID | Term |
|---|---|
| D008134 | Long-Term Care |
| ID | Term |
|---|---|
| D005791 | Patient Care |
| D013812 | Therapeutics |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
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