Implementing, Evaluating, and Scaling Up of the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) Program

NCT03935997 | Active Not Recruiting

• 1 other identifier: SPA-LTC408466
• Study Type: interventional
• Target: 594
• Locations: 1 country
• Sites: 4

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).

Conditions

Frail Elderly Syndrome

Keywords

Palliative care; End of life care; Long-term care; Nursing home

Outcome Measures

Primary Outcomes (1)

• 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 Outcomes (7)

• 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.

• 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.

• 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

• 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.

• 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.

Other Outcomes (1)

• Fidelity of the Intervention

  Checklist completed weekly during the intervention period for up to 160 weeks.

Study Arms (2)

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.

Other: Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) Program

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.

Interventions

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.

Intervention

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• English-speaking LTC residents with a score of 50% or less on the Palliative Performance Scale.

You may not qualify if:

• Non-English speaking LTC residents
• residents with a score of more than 50% on the Palliative Performance Scale.

Sponsors & Collaborators

• McMaster University: lead
• Alberta Health services: collaborator
• Hospice Palliative Care Ontario: collaborator
• Canadian Hospice Palliative Care Association: collaborator
• Canadian Virtual Hospice: collaborator
• Saskatchewan Health Authority - Regina Area: collaborator
• Interlake-Eastern Regional Health Authority: collaborator

Study Sites (4)

University of Manitoba

Winnipeg, Manitoba, Canada

Location

McMaster University

Hamilton, Ontario, Canada

Location

University of Regina

Regina, Saskatchewan, Canada

Location

University of Saskatchewan

Saskatoon, Saskatchewan, Canada

Location

Related Publications (5)

• 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.

  PMID: 30583908 BACKGROUND

• 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.

  PMID: 30207512 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.

  PMID: 29308424 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.

  PMID: 29284551 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.

  PMID: 29271241 BACKGROUND

Related Links

• SPA-LTC webpage (housed on the Canadian Hospice Palliative Care Association website)

MeSH Terms

Interventions

Long-Term Care

Intervention Hierarchy (Ancestors)

Patient Care; Therapeutics; Health Services; Health Care Facilities Workforce and Services

Study Officials

• Sharon Kaasalainen, PhD

  McMaster University, School of Nursing

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: There is no need to mask participants, clinicians or research staff.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: 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.

Study Record Dates

• First Submitted: April 26, 2019
• First Posted: May 2, 2019
• Study Start: June 1, 2022
• Primary Completion: January 31, 2025
• Study Completion: January 31, 2026
• Last Updated: September 25, 2025

Record last verified: 2024-11

Data Sharing

• IPD Sharing: Will not share

Locations

CA (4)