Implementation of Pathway for Goals of Care and End of Life Management in L
There is a dire need to improve palliative care for frail older adults in long-term care (LTC) across Canada, since almost 40% of Canadians die in LTC. Palliative care, (i.e., supportive care for LTC residents during the final months or years of life), can relieve pain & other distressing symptoms & maintain quality of life. The COVID pandemic has drawn attention to the many barriers to providing palliative care to frail residents of LTC, including unpredictable dying trajectories associated with frailty, barriers to discussing end-of-life within Canadian culture, & limited palliative care knowledge & skills among LTC staff, combined with excessive workloads. Frailty is under-diagnosed in LTC & is often unpredictable in its presentation & progression. However, it is a life-limiting condition associated with increased comorbidity, high levels of physical, emotional & social disability, & an unpredictable illness trajectory. Recent research by our team (unpublished) identified the steps needed to effectively provide palliative care in LTC: i) restructure the physical setting, ii) provide education/skills training, iii) deliver care integration, iv) engage families & v) broaden the meaning of frailty. The COVID pandemic has highlighted the urgent need to improve palliative care that is specific to LTC residents with frailty, yet effective & practical care strategies for this complex care setting must be developed. We propose developing a clinical pathway that focuses on frailty & early palliative care for LTC residents, leading to improved care planning & outcomes. Our overarching goal is to develop an evidence-based care pathway for early recognition of frailty & initiation of early palliative care for LTC residents, appropriate to degree of frailty. An integrated knowledge translation approach & the Knowledge to Action (KTA) cycle will be used to achieve the following three research objectives: • Develop an evidence-informed care pathway focused on diagnosing & managing frailty, which includes incorporating early palliative care in LTC (KTA: Knowledge Creation); • Understand barriers & facilitators to this care pathway in LTC. (KTA: Assessing Barriers); • Develop & pilot an implementation strategy for the pathway. (KTA: Select & Tailor Implementation Interventions).
