New grant funds next phase of end-of-life research program
Feb 21, 2019
Photo above: Dr. Sharon Kaasalainen
How can engaging patients and families in end-of-life decisions improve our last days of life?
That’s one of the key questions that will be addressed during a newly funded study that will take place in several long-term care homes in Canada over the next five years.
Dr. Sharon Kaasalainen, a professor in McMaster’s School of Nursing, is the principal investigator on a new research project, “Implementing, evaluating and scaling up the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) program in Canada”. Her team was recently awarded a research grant of $948,600 by the Canadian Institutes of Health Research (CIHR).
This new study will build upon an earlier study that is just wrapping up, says Kaasalainen. Over a period of four years, Kaasalainen has worked with her team and partners to introduce a philosophy of care called the “palliative approach” in several long-term care homes in four provinces in Canada.
To Kaasalainen, in this context the “palliative approach” meant that “we were trying to get communication, symptom management and advanced care planning happening earlier on, rather than having to make difficult decisions with families when they are not prepared for them and often in crisis mode. The project involved several components including a tool that staff could use to help identify residents nearing the end of life or when there’s been significant decline. This triggered a Family Care Conference. Staff talked to the resident and/or family about goals of care, symptom management issue, and developed a plan of care together. Staff asked about the kinds of things the resident normally enjoys. Is it music or massage therapy? What are their spiritual beliefs that they would like supported? Do they want to go to the hospital or stay in the long-term care home?”
The previous project showed that “with the implementation of this program, we can improve advance care planning uptake and end-of-life communication for those in long-term care and their families, decrease hospital transfers at the end of life, and increase satisfaction of care for all stakeholders.” There was a 55% reduction in the number of emergency department visits in the last year of life for residents who participated in the study.
“We were piloting the program but at the same time adapting it so it could be implemented within different contexts in four provinces,” says Kaasalainen. “Every province and region is different. We’ve had such good results and feedback that we now want to scale up this program across more homes.”
Kaasalainen explains that researchers are trying to leverage resources in the community to help implement the program. “In the first study we conducted a scan and developed strong partnerships with the local communities.” The new study will further build on these relationships and bring in new partners with the enlarged scope.
Innovation and long term care