A pilot evaluation of the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) program

Kaasalainen, Sharon; Sussman, Tamara; Thompson, Genevieve; McCleary, Lynn; Hunter, Paulette V.; Venturato, Lorraine; Wickson-Griffiths, Abigail; Ploeg, Jenny; Parker, Deborah; Sinclair, Shane; Bello-Haas, Vanina Dal; Earl, Marie; You, John J.

doi:10.1186/s12904-020-00599-w

Cited by 12 publications

(15 citation statements)

References 30 publications

(39 reference statements)

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“…The booklet could be used as a mechanism with which to frame some discussion about ACP during a care conference when the doctor is present and available to answer questions and provide additional information to meet the needs of residents and families. Care conferences allow for shared decision-making and improve family satisfaction ( Durepos et al, 2018 ; Kaasalainen et al, 2020 ). Future research is needed to evaluate the effectiveness of using the CSK booklet to help prepare families better for discussions during a care conference with the health care team, including the doctor.…”

Section: Discussionmentioning

confidence: 99%

“…Annual mortality rates of residents in LTC homes range from 27–52.3% ( Canadian Institute for Health Information, 2020 ). Yet research has shown that LTC homes do not support residents and their families well within a palliative approach to care, with lack of attention given to advance care planning (ACP) that can lead to inappropriate hospitalizations and lingering issues during grief and bereavement ( Kaasalainen et al, 2020 ; Martin et al, 2016 ; Stewart et al, 2011 ; Thompson et al, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the Implementation of the Conversation Starter Kit in Long Term Care

et al. 2021

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Introduction Advance care planning can improve the quality of life for residents in long-term care homes and reduce stress for families. However, care home staff and families often lack knowledge about advance care planning, making it especially difficult for residents with dementia to communicate their care plan wishes. A Conversation Starter Kit may increase advance care planning awareness among staff and families. Objectives This study evaluated an advance care planning intervention, the Conversation Starter Kit booklet, for use in long term care homes. Methods Data were collected at three long-term care homes in southern Ontario. We collected data from 55 residents who were able to make decisions on their own paired with 11 family members of these residents. We also collected data from 24 family members of residents who were unable to make decisions on their own. This study used a quasi-experimental, one group pre/post design. Quantitative surveys were administered before and after a three-month advance care planning intervention. An additional structured interview was completed at the end of the intervention period, which included both closed and open-ended questions to assess perceptions about the booklet's use or non-use. Results Residents reported more engagement in advance care planning after completing the Conversation Starter Kit booklet, particularly related to asking questions to health care providers about health care decisions. Family members reported feeling very certain that they would be able to make decisions on behalf of the resident but felt less certain after completing the booklet, implying the booklet raised their awareness of the types of decisions they might need to make, hopefully prompting them to be more prepared for decisions in the future. Conclusions An advance care planning intervention – The Conversation Starter Kit booklet - appears acceptable and easy to use for residents and family members/friends in long-term care and can improve resident engagement in advance care planning. Although using the booklet may decrease efficacy for decision making among family members of long-term care residents, it may highlight the importance of more actionable engagement in advance care planning among residents, their families/friends, and staff.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluating the Implementation of the Conversation Starter Kit in Long Term Care

et al. 2021

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“…These LTCHs were selected as they were representative of the contexts seen in homes across Canada in terms of ownership (for profit, not for profit) and size (number of beds ranging from < 100 to > 150). The size and ownership have been found to have impact in successful enactment of a new initiative [40]. Maximum variation sampling was used by recruiting various categories of staff to gather rich information on prevailing and distinctive perspectives on ACP in the context of LTCHs [36].…”

Section: Participants and Settingmentioning

confidence: 99%

Interdisciplinary staff perceptions of advance care planning in long-term care homes: a qualitative study

et al. 2022

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Background Residents living in long-term care homes (LTCH) have complex care needs, multiple chronic conditions, increasing frailty and cognitive impairment. A palliative approach that incorporates advance care planning (ACP) should be integrated with chronic disease management, yet it is not a norm in most LTCHs. Despite its growing need, there remains a lack of staff engagement in the ACP process. Objectives The aim of this study was to explore the perceptions and experiences of interdisciplinary staff related to the practice of ACP in LTCHs. Methods This study is part of a larger Canadian project, iCAN ACP, that aims to increase uptake, and access to ACP for older Canadians living with frailty. An exploratory qualitative design using an interpretive descriptive approach was employed utilizing focus groups and semi-structured interviews with staff from four LTCHs in Ontario, Canada. Findings There were 98 participants, including nurses (n = 36), physicians (n = 4), personal support workers (n = 34), support staff (n = 23), and a public guardian (n = 1). Three common themes and nine subthemes were derived: a) ongoing nature of ACP; b) complexities around ACP conversations; and c) aspirations for ACP becoming a standard of care in LTCHs. Discussion The findings of this study provide important contributions to our understanding of the complexities surrounding ACP implementation as a standard of practice in LTCHs. One of the critical findings relates to a lack of ACP conversations prior to admission in the LTCHs, by which time many residents may have already lost cognitive abilities to engage in these discussions. The hierarchical nature of LTCH staffing also serves as a barrier to the interdisciplinary collaboration required for a successful implementation of ACP initiatives. Participants within our study expressed support for ACP communication and the need for open lines of formal and informal interdisciplinary communication. There is a need for revitalizing care in LTCHs through interdisciplinary care practices, clarification of role descriptions, optimized staffing, capacity building of each category of staff and commitment from the LTCH leadership for such care. Conclusion The findings build on a growing body of research illustrating the need to improve staff engagement in ACP communication in LTCHs.

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“…Further, the generic nature of the tool does not necessitate that persons with dementia accept their diagnosis prior to use, thus overcoming an obstacle to advance care planning conversations identified by family/caregivers and health providers ( Hirschman et al, 2008 ). Finally, the tool has already been pilot tested for use with older persons living with frailty ( Kaasalainen et al, 2020 ; Lum et al, 2020 ).…”

Section: Your Conversation Starter Kitmentioning

confidence: 99%

“This is how I want it”: Exploring the use of a workbook with persons with dementia to support advance care planning engagement

2022

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This mixed method sequential study reports focus group and pilot intervention findings that (1) explore the views of persons with dementia and their caregivers on using a self-directed advance care planning engagement workbook ( Your Conversation Starter Kit) and (2) uncover the conditions that encouraged and hindered workbook use. In Phase 1, we conducted five focus groups consisting of 10 persons with dementia and eight family members/caregivers from two urban Canadian cities to explore overall impressions of the workbook and factors that might affect its use. In Phase 2, we empirically explored the factors identified in Phase 1 by distributing the workbook to 24 persons with dementia. The combined findings suggest that the workbook offers promise in supporting advance care planning engagement for persons with dementia in the early stages of their condition. Involving family/caregivers and clarifying some of the ranked questions might improve the workbook’s use. Persons with dementia without familial support or those who have never contemplated advance care planning may require additional guidance prior to workbook distribution.

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A pilot evaluation of the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) program

Cited by 12 publications

References 30 publications

Evaluating the Implementation of the Conversation Starter Kit in Long Term Care

Evaluating the Implementation of the Conversation Starter Kit in Long Term Care

Interdisciplinary staff perceptions of advance care planning in long-term care homes: a qualitative study

“This is how I want it”: Exploring the use of a workbook with persons with dementia to support advance care planning engagement

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