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

NCT ID: NCT03935997

Last Updated: 2025-09-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

594 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-06-01

Study Completion Date

2026-01-31

Brief Summary

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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).

Detailed Description

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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.

Conditions

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Frail Elderly Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

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.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

There is no need to mask participants, clinicians or research staff.

Study Groups

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Intervention

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.

Group Type EXPERIMENTAL

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

Intervention Type 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.

Control

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.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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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.

Intervention Type OTHER

Eligibility Criteria

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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.
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Alberta Health services

OTHER

Sponsor Role collaborator

Hospice Palliative Care Ontario

UNKNOWN

Sponsor Role collaborator

Canadian Hospice Palliative Care Association

UNKNOWN

Sponsor Role collaborator

Canadian Virtual Hospice

UNKNOWN

Sponsor Role collaborator

Saskatchewan Health Authority - Regina Area

OTHER

Sponsor Role collaborator

Interlake-Eastern Regional Health Authority

UNKNOWN

Sponsor Role collaborator

McMaster University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Sharon Kaasalainen, PhD

Role: PRINCIPAL_INVESTIGATOR

McMaster University, School of Nursing

Locations

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University of Manitoba

Winnipeg, Manitoba, Canada

Site Status

McMaster University

Hamilton, Ontario, Canada

Site Status

University of Regina

Regina, Saskatchewan, Canada

Site Status

University of Saskatchewan

Saskatoon, Saskatchewan, Canada

Site Status

Countries

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Canada

References

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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.

Reference Type BACKGROUND
PMID: 30583908 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 30207512 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 29308424 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 29284551 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 29271241 (View on PubMed)

Related Links

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Other Identifiers

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SPA-LTC408466

Identifier Type: -

Identifier Source: org_study_id

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