Evaluation of the STEP Intervention for Long-Term Care Residents Facing Hospital Transfer Decisions

NCT07153341 | Recruiting

• 2 other identifiers: M16-25-017478736
• Study Type: interventional
• Target: 200
• Locations: 1 country
• Sites: 2

Brief Summary

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.

Conditions

LTC-to-hospital Transfer Decision-making

Keywords

long-term care; hospital transfers; acute health events; decision-making in older adults; resident-centred care; substitute decision-makers; frailty; cognitive impairment; shared decision-making; avoidable hospitalizations; transitional care; decision aid; health decision support; decision coaching; pre-post intervention study; healthcare quality improvement; decisional conflict; decisional regret

Outcome Measures

Primary Outcomes (1)

• Decisional Conflict

  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).

  Administered by Research Assistant 1-6 weeks after a transition decision.

Secondary Outcomes (3)

• 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.

• Resident Health Outcomes Post-Transition

  Measured continuously during the 6 months pre-intervention and 6 months post-intervention periods.

Study Arms (1)

STEP Intervention

EXPERIMENTAL

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.

Behavioral: STEP Decision Support Toolkit

Interventions

STEP Decision Support Toolkit BEHAVIORAL

The STEP toolkit includes (1) an educational booklet provided upon admission and annually, (2) condition-specific decision aids addressing common clinical scenarios, and (3) structured phone scripts for staff. STEP empowers residents and care partners to actively engage in decision-making, promotes care aligned with personal values, and supports staff in facilitating advance care planning to reduce unnecessary or complex transitions.

STEP Intervention

Eligibility Criteria

• Age: 55 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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.
• LTC staff:
• 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.

Sponsors & Collaborators

• Bruyère Health Research Institute.: lead

Study Sites (2)

Bruyère Health Saint-Louis Long-Term Care

Ottawa, Ontario, K1C 2Z6, Canada

RECRUITING

Perley Health

Ottawa, Ontario, K1G 4B2, Canada

RECRUITING

Related Publications (8)

• Tappen RM, Elkins D, Worch S, Weglinski M. Modes of Decision Making Used by Nursing Home Residents and Their Families When Confronted With Potential Hospital Readmission. Res Gerontol Nurs. 2016 Nov 1;9(6):288-299. doi: 10.3928/19404921-20160920-01. Epub 2016 Sep 27.

  PMID: 27665753 BACKGROUND

• Marincowitz C, Preston L, Cantrell A, Tonkins M, Sabir L, Mason S. What influences decisions to transfer older care-home residents to the emergency department? A synthesis of qualitative reviews. Age Ageing. 2022 Nov 2;51(11):afac257. doi: 10.1093/ageing/afac257.

  PMID: 36413591 BACKGROUND

• Gruneir A, Bronskill SE, Newman A, Bell CM, Gozdyra P, Anderson GM, Rochon PA. Variation in Emergency Department Transfer Rates from Nursing Homes in Ontario, Canada. Healthc Policy. 2016 Nov;12(2):76-88.

  PMID: 28032826 BACKGROUND

• Gruneir A, Anderson GM, Rochon PA, Bronskill S. Transitions in long-term care and potential implications for quality reporting in Ontario, Canada. J Am Med Dir Assoc. 2010 Nov;11(9):629-35. doi: 10.1016/j.jamda.2010.07.007.

  PMID: 21029997 BACKGROUND

• Cummings GG, McLane P, Reid RC, Tate K, Cooper SL, Rowe BH, Estabrooks CA, Cummings GE, Abel SL, Lee JS, Robinson CA, Wagg A. Fractured Care: A Window Into Emergency Transitions in Care for LTC Residents With Complex Health Needs. J Aging Health. 2020 Mar;32(3-4):119-133. doi: 10.1177/0898264318808908. Epub 2018 Nov 15.

  PMID: 30442040 BACKGROUND

• Abraham S, Menec V. Transitions Between Care Settings at the End of Life Among Older Homecare Recipients: A Population-Based Study. Gerontol Geriatr Med. 2016 Dec 15;2:2333721416684400. doi: 10.1177/2333721416684400. eCollection 2016 Jan-Dec.

  PMID: 28680944 BACKGROUND

• Menard A, Singh Y, Adams M, Bai JQA, Kobewka D, MacLeod KK. "We Didn't Ask to Be Sick:" Equipping Residents and Care Partners for Transitions From Long-Term Care to Hospital. J Am Geriatr Soc. 2025 Aug;73(8):2410-2421. doi: 10.1111/jgs.19535. Epub 2025 May 30.

  PMID: 40444661 BACKGROUND

• Menard A, Konikoff L, Adams M, Singh Y, Scott MM, Yin CY, Kimura M, Kobewka D, Fung C, Isenberg SR, Kaasalainen S, Kierulf J, Molnar F, Shamon S, Wilson K, Kehoe MacLeod K; Ottawa Hospital Research Institute and Bruyere Health Research Institute. Supporting resident-centred decision-making about transitions from long-term care homes to hospital: a qualitative study protocol. BMJ Open. 2024 Nov 29;14(11):e086748. doi: 10.1136/bmjopen-2024-086748.

  PMID: 39615892 BACKGROUND

MeSH Terms

Conditions

Frailty; Cognitive Dysfunction

Condition Hierarchy (Ancestors)

Pathologic Processes; Pathological Conditions, Signs and Symptoms; Cognition Disorders; Neurocognitive Disorders; Mental Disorders

Central Study Contacts

Daniel Kobewka, MD

CONTACT

613-798-5555; DKobewka@toh.ca

Alixe Ménard, MSc, PhD(c)

CONTACT

613-798-5555; alimenard@ohri.ca

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This trial uses a pre-post evaluation design at two LTC sites. All participants receive the same intervention (the STEP tool), with no comparison group or randomization to different arms. Outcomes are compared before and after the intervention within the same group (resident-care partner dyads and nurses).

Study Record Dates

• First Submitted: August 19, 2025
• First Posted: September 3, 2025
• Study Start: October 1, 2025
• Primary Completion: March 4, 2026
• Study Completion (Estimated): September 1, 2027
• Last Updated: February 6, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

CA (2)