Hsu, Amy T | $150,000

Ontario Bruyère Research Institute 2020 CIHR Operating Grant

Palliative care is commonly misunderstood as only being relevant for people who are actively dying and in the final weeks or days of life. However, the relief of suffering through the provision of holistic and compassionate care is an essential component of care for all patients with a life-threatening illness. For care of residents with and without COVID-19, palliative care approaches are vital to quality care in LTC. However, the capacity of LTC homes to introduce and embed palliative care approaches can be hindered by poor communication about prognosis. Clinicians, even palliative care specialists, often have difficulty estimating survival beyond a few weeks. Unfortunately, many existing frailty and mortality indices present the outcome as a probability of death or a risk score on a mortality-based index, which are not easily actionable for either clinicians or patients and their families. In this project, we propose to rapidly implement and evaluate the Risk Evaluation for Support: Predictions for Elder-life in the Community Tool in LTC (RESPECT–LTC) to support their ongoing efforts to embed palliative approaches to care in their processes and culture. RESPECT–LTC is a mortality-risk communication tool that accurately predicts an older person’s six-month mortality risk as well as life expectancy to inform clinicians’ decisionmaking regarding the initiation of palliative and/or end-of-life care. RESPECT–LTC was co-designed with patients and caregivers. It informs care providers, residents and their families when the resident may be approaching the end of life by estimating their survival in days, weeks and months—a metric that has been shown to be patient-oriented and meaningful for care planning. In alignment with the goals of the LTC+ program, we will support LTC homes’ implementation and evaluation of promising practices in palliative and end-of-life care based on prognoses generated from RESPECT–LTC. We will achieve this by: 1. Enhancing the assessment of, and clinical decision-making, regarding of palliative care needs using RESPECT–LTC, a validated evidence-based tool; 2. Assessing the acceptability of RESPECT–LTC by individuals spanning the decision-making and care hierarchy in LTC; 3. Supporting implementation science-informed skills training in end-of-life communication for clinicians practising in LTC; 4. Developing recommendations for care pathways in LTC residents based on prognostic information (i.e., mortality risk and life expectancy) generated from RESPECT–LTC; 5. Evaluating the effectiveness of RESPECT–LTC in supporting a palliative care approach and improved resident outcomes in LTC.

With funding from the Government of Canada

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