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

September 24, 2025 updated by: McMaster University
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).

Study Overview

Status

Active, not recruiting

Conditions

Intervention / Treatment

Detailed Description

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.

Study Type

Interventional

Enrollment (Estimated)

594

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • Manitoba
      • Winnipeg, Manitoba, Canada
        • University of Manitoba
    • Ontario
      • Hamilton, Ontario, Canada
        • McMaster University
    • Saskatchewan
      • Regina, Saskatchewan, Canada
        • University of Regina
      • Saskatoon, Saskatchewan, Canada
        • University of Saskatchewan

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

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.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: 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.
Other: 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.
No Intervention: 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Number of Emergency Department Visits in the Resident's Last Year of Life
Time Frame: All residents in the home who died one year prior to the implementation and one year prior to the date of death for all residents in the home who die during the study intervention period.
All residents in the home who died one year prior to the implementation and one year prior to the date of death for all residents in the home who die during the study intervention period.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Family Perceptions of End of Life Care
Time Frame: Survey completed at enrolment into the study; survey completed 2 months after the Family Care Conference or 1 month after the end of the intervention period if no Family Care Conference occurred.
Survey
Survey completed at enrolment into the study; survey completed 2 months after the Family Care Conference or 1 month after the end of the intervention period if no Family Care Conference occurred.
Family Experiences with End of Life Care
Time Frame: Interview completed at enrolment into the study; survey completed 2 months after the Family Care Conference or 1 month after the end of the intervention period if no Family Care Conference occurred.
Interview
Interview completed at enrolment into the study; survey completed 2 months after the Family Care Conference or 1 month after the end of the intervention period if no Family Care Conference occurred.
Number of Hospital Transfers per Resident
Time Frame: Chart audit at start of the trial to capture data on residents who died in the year prior to the trial. Chart audits also during the transition phase prior to Steps 2 and 3; and one month after the intervention period for the trial ends.
Chart data at each study site will be audited to capture data on the number of hospital transfers in the last year of life for residents who died 1 year before the trial or who die during the trial.
Chart audit at start of the trial to capture data on residents who died in the year prior to the trial. Chart audits also during the transition phase prior to Steps 2 and 3; and one month after the intervention period for the trial ends.
Number of Hospital Deaths during the trial
Time Frame: Chart audit at start of the trial to capture data on residents who died in the year prior to the trial. Chart audits also during the transition phase prior to Steps 2 and 3; and one month after the intervention period for the trial ends.

Chart data at each study site will be audited to capture data on the number of hospital deaths in the year prior to the trial and during the trial.

Chart data at each study site will be audited to capture data on the number of hospital transfers in the residents last year of life.
Chart audit at start of the trial to capture data on residents who died in the year prior to the trial. Chart audits also during the transition phase prior to Steps 2 and 3; and one month after the intervention period for the trial ends.
Bereaved Family Satisfaction with End of Life Care
Time Frame: 6 weeks to 2 months after the resident's death
Qualitative interview with family members whose loved one died during the trial.
6 weeks to 2 months after the resident's death
Resident Satisfaction with End of Life Care
Time Frame: At the time of enrolment and 2 months after the Family Care Conference or 1 month after the intervention period if no Family Care Conference occurred.
Qualitative interview with residents who are enrolled in the trial
At the time of enrolment and 2 months after the Family Care Conference or 1 month after the intervention period if no Family Care Conference occurred.
Staff Knowledge about a Palliative Approach to Care
Time Frame: All staff in all participating long-term care homes will complete a staff survey at 2 points in the study: at the beginning and the end of the intervention
Survey
All staff in all participating long-term care homes will complete a staff survey at 2 points in the study: at the beginning and the end of the intervention

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Fidelity of the Intervention
Time Frame: Checklist completed weekly during the intervention period for up to 160 weeks.
Checklist
Checklist completed weekly during the intervention period for up to 160 weeks.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

McMaster University

Collaborators

Alberta Health services
Saskatchewan Health Authority - Regina Area
Canadian Virtual Hospice
Hospice Palliative Care Ontario
Canadian Hospice Palliative Care Association
Interlake-Eastern Regional Health Authority

Investigators

  • Principal Investigator: Sharon Kaasalainen, PhD, McMaster University, School of Nursing

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 1, 2022

Primary Completion (Actual)

January 31, 2025

Study Completion (Estimated)

January 31, 2026

Study Registration Dates

First Submitted

April 26, 2019

First Submitted That Met QC Criteria

May 1, 2019

First Posted (Actual)

May 2, 2019

Study Record Updates

Last Update Posted (Estimated)

September 25, 2025

Last Update Submitted That Met QC Criteria

September 24, 2025

Last Verified

November 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • SPA-LTC408466

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

There is no plan to make individual participant data (IPD) available to other researchers.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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