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

Frail Elderly Syndrome Clinical Trial

Official title:

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

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03935997
• Other study ID #: SPA-LTC408466
• Status: Active, not recruiting
• Phase: N/A
• Start date: June 1, 2022
• Est. completion date: January 31, 2025

Study information

• Verified date: March 2024
• Source: McMaster University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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).

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 information / eligibility

• Status: Active, not recruiting
• Enrollment: 594
• Est. completion date: January 31, 2025
• Est. primary completion date: January 31, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

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

Exclusion Criteria:

• Non-English speaking LTC residents

• residents with a score of more than 50% on the Palliative Performance Scale.

Related Conditions & MeSH terms

• Frail Elderly Syndrome

Intervention

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

Locations

Country	Name	City	State
Canada	McMaster University	Hamilton	Ontario
Canada	University of Regina	Regina	Saskatchewan
Canada	University of Saskatchewan	Saskatoon	Saskatchewan
Canada	University of Manitoba	Winnipeg	Manitoba

Sponsors (7)

Lead Sponsor	Collaborator
McMaster University	Alberta Health services, Canadian Hospice Palliative Care Association, Canadian Virtual Hospice, Hospice Palliative Care Ontario, Interlake-Eastern Regional Health Authority, Saskatchewan Health Authority - Regina Area

Country where clinical trial is conducted

Canada, 

References & Publications (5)

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. — View Citation

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. — View Citation

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. — View Citation

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. — View Citation

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. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Fidelity of the Intervention	Checklist	Checklist completed weekly during the intervention period for up to 160 weeks.
Primary	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	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.
Secondary	Family Experiences with End of Life Care	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.
Secondary	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
Secondary	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.
Secondary	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.
Secondary	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
Secondary	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.

External Links

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