Grant: Partnerships for Health System Improvement (PHSI)

Advocacy Centre for Elderly (Toronto, ON); Canadian Virtual Hospice (Winnipeg, MB); Canadian Hospice Palliative Care Association (Ottawa); Interlake-Eastern Regional Health Authority (Selkirk, MB)); Alberta Innovates (Edmonton); Alzheimer Society of Canada; Manitoba Health Research Council; CIUSSS de Centre-Ouest-de-l'Ile-de-Montréal-Cavendish; Winnipeg Regional Health Authority; Calgary Health Region; Ontario Ministry of Health and Long Term Care; Saskatoon Health Region (Saskatchewan); Saskatchewan Health Research Foundation; Tabor Manor (St. Catharines, ON)

<html> <body> <strong>Background:</strong> Residents living and dying in long term care (LTC) homes represent one of society&rsquo;s most frail and marginalized populations of older adults. As the population ages, more people will die in LTC homes. In Canada, currently 27% of residents die in LTC, and this rate will rise to 39% by the year 2020. Similar trends have been noted from other countries including the United States, the United Kingdom, and Australia. Despite these growing rates, research has shown that palliative care is suboptimal in LTC; with pain and other symptoms being poorly managed, lack of attention given to advance care planning,and issues of loss, grief and bereavement, widespread use of feeding tubes, and excessive reliance on hospitalizations. Clearly, palliative care for residents in LTC and their family members is inadequate and requires attention. Despite the high mortality rates in LTC, most LTC homes do not have a formalized palliative care program. Recent pilot work of the team has explored a variety of individual tools and practices aimed at improving palliative care in LTC, but they have not been implemented nor evaluated altogether as a program. Further research is needed to evaluate this program to improve palliative care outcomes across all levels of care (i.e, resident, family, health care provider, system) across a number of provinces in Canada.<br> <br>The <strong>goal of this proposed research</strong> is to implement and evaluate a palliative care program that includes the following core, evidence-informed components: (a) an interdisciplinary champion team (to provide leadership and support implementation); (b) the Palliative Performance Scale&nbsp;as one trigger for end-of-life discussions; (c) Family Care Conferences (one two weeks post admission and when need for palliative end-of life care planning is identified); (d) Comfort Care Rounds with staff (for capacity building and reflection); and (e) post bereavement follow up for residents, families, and staff.<br> <br> <strong>Methods:</strong> Guided by a participatory action research approach, this study will use a mixed method (qualitative and quantitative) multiple case study design to address the study objectives. This study will be conducted in four separate LTC homes or 'cases'&nbsp;across four provinces in Canada (ON, MB, SK, AB) which represent the mix of contexts found in LTC homes across Canada.&nbsp; We will collect data before the intervention, during the intervention, and after the intervention. The Ottawa Model of Research Use will be used to guide the implementation of the intervention and provide the basis for integrated knowledge translation activities throughout this project, beginning with an environmental scan, and later the development of knowledge translation products (e.g., toolkit, video) that can be widely used in the &lsquo;scaling up&rsquo; of the intervention in future work. We will work with our study partners to ensure that materials are condensed, readable, relevant, persuasive, culturally sensitive and relevant to maximize adoption into practice.<br> <br> <strong>Significance:</strong> The findings of this study have the potential to improve the quality of life of older adults living and dying in LTC and provide better support to their families. Given the growing aging population, the proposed study promises to offer valuable information on implementation processes, clinical and administrative tools, and educational materials that will inform how qualified health professionals and decision-makers can improve the delivery of palliative care in LTC globally.</body> </html>