More about the SPA-LTC Project Findings

Findings

Baseline

  • Focus groups with LTC home staff, residents, and families (N=20) highlighted that understandings of comfort limited the integration of palliative care principles to the final days of residents’ lives
  • Support staff’s comfort of working with dying patients and their level of interdisciplinary coordination were significantly lower compared to both nurses and PSWs
  • Bereaved family members who perceived a resident as having received good care reported less resident emotional distress at end-of-life and those families who received support from staff perceived less resident emotional distress at end of life
  • Chart audits revealed that 26% of LTC residents on average across all four sites died in the past year with the majority of resident deaths occurring at the LTC home; 65.3% of them visited Emergency Departments (ED) during the last year of life; 45.8% with ED visits in last month of life and 27.1% occurred during their last week of life

SPA Implementation and Evaluation

  • Palliative Care Champion Teams: Increased interdisciplinary communication and cooperation providing a gateway for staff to access palliative care information and resources
  • Comfort Care Rounds (CCRs): Provided monthly opportunities for collective problem-solving and case based learning. Common issues discussed included managing sudden resident deaths, navigating complex family dynamics, and balancing the divergent needs of families and residents.
  • Illness Trajectory Pamphlets: Were seen as providing valuable information to residents and families about what to expect with different health conditions. Information about what a palliative approach is and how advance care planning (ACP) can support quality end of life care were particularly appreciated by residents and families. Two-thirds of residents and family members reported increased comfortable exploring ACP after reading a pamphlet.
  • Palliative Performance Scale: was implemented with all enrolled residents (39/39) of which almost all (37/39) scored between 30%-40% which is suggestive of a transitions from restorative to end of life care.
  • Family Care Conferences: were offered to 62% of enrolled residents (24/39). Issues most commonly discussed were preferences for physical and care at end-of-life. Conferences that were interdisciplinary discussed more aspects of end-of-life care. The majority of families who participated in the conferences reported their concerns and issues around end of life care were addressed and that the conferences were valuable in supporting good communication with staff.

Outcomes

  • There were no significant pre-post differences of bereaved families’ perceptions of residents’ end of life comfort and families’ overall perceptions of care
  • Chart audit revealed reductions in the number of ER visits, more planned or appropriate ER visits and fewer ER admissions that became hospital admissions
  • Staff’s, resident’s and families’ perceptions of all components of the SPA-LTC intervention were positive and indicated perceived improvements in communication and comfort with end-of-life issues

Impact

The importance of our findings to the care of the seriously ill, frail elderly and their caregivers revealed that with the implementation of this program we can improve advance care planning uptake and end of life communication for those living and dying in LTC and their families, decrease hospital transfers at the end of life and increase satisfaction of care for all stakeholders. During the course of our project, we developed materials to improve resident access to ACP and to ensure bereavement support for families. Results also suggest the pamphlets offer important information that improve resident and family comfort with engaging in ACP conversations.

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