"Help with rowing the boat": Implementing and evaluating the Strengthening a Palliative Approach in Long-Term Care program in four Canadian provinces.

Abstract

Background: Despite high mortality rates in long-term care (LTC), LTC homes continue to struggle to implement a palliative approach to care.

Objectives: The objective of this research was to implement and evaluate the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC; www.spaltc.ca) program. Specifically, we explored its feasibility, acceptability, and preliminary effects on resident comfort, use of emergency department at end-of-life (EOL), and location of resident death.

Design: This study used an explanatory mixed method design in four LTC homes; one in each of four provinces (Ontario, Manitoba, Saskatchewan, Alberta) in Canada to assess acceptability, feasibility, and preliminary effects of the program.

Methods: Quantitative and qualitative data were collected whereby the qualitative component was used to help explain or elaborate on the main quantitative components.

Results: Of the 102 participating residents, 74.5% (76/102) had a Palliative Care Conference (PCC). However, of those who died, only 68.8% of them had a PCC. Rates of hospital use were reduced for study participants in terms of emergency department visits at EOL (relative risk reduction (RRR): 46%; 95% CI: -1.12, -0.10) and hospital deaths (RRR: 88%; 95% CI: -4.06, -1.12) compared to baseline. However, there were no significant differences in resident comfort. Family members stated that the PCCs were informative and thought that good communication was critical in providing quality care. They highlighted that close relationships and mutual respect among staff, residents, and families led to more meaningful care while the resident was alive as well as into bereavement. Staff stated that they found the SPA-LTC resources helpful and recognized the importance of having strong leadership using a Palliative Champion Team.

Conclusion: The SPA-LTC program appears to be feasible on some key activities and supports a family-centered approach to care, which relies on strong communication. Future research is needed to confirm these initial results.