Evaluation of the STEP Intervention for Long-Term Care Residents Facing Hospital Transfer Decisions
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age55+
SponsorBruyère Health Research Institute.
About this trial
This trial will evaluate whether the Supporting Transitions and Empowering Preferences (STEP) toolkit can improve decision-making about hospital transfers in long-term care residents and their substitute decision-makers and enhance decision self-efficacy in nursing staff.
The trial will answer the questions:
* Does the STEP tool reduce decisional conflict in residents and care partners at the time of transfer decisions? * Does it improve nurse self-efficacy related to hospital transfer decisions?
Participants will:
* Use the STEP tool during key moments of care planning (admission, care conferences, and acute events) * Complete a short survey measuring their decisional conflict * Be supported by trained nurses who use STEP to guide hospital transfer discussions
Researchers will compare data collected before and after the STEP tool is implemented at two long-term care homes to see if it improves shared decision-making related to hospital transfers by reducing decisional conflict.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Must be residents of either Perley Health or Bruyère Health Saint-Louis LTC home.
Residents must be 55 years of age or older.
Must be able to communicate in French or English.
Must be a nurse, nurse practitioner, social service worker or physician actively involved in care planning, annual conferences, or managing acute health events at Perley Health or Bruyère Health.
Disqualifiers
None
Trial design
Design model
Single group
Treatments tested in this trial
STEP Decision Support Toolkit
BehavioralThe STEP toolkit includes (1) an educational booklet provided upon admission and annually, (2) condition-specific decision aids addressing common clinical scenarios, and (3) structured phone scripts for staff. STEP empowers residents and care partners to actively engage in decision-making, promotes care aligned with personal values, and supports staff in facilitating advance care planning to reduce unnecessary or complex transitions.
Treatment groups
200 Participants
are divided into 1 treatment groupGroup A: STEP InterventionExperimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
Decisional Conflict
Measured using the Decisional Conflict Scale (16 items; each rated on a 5-point scale; standardized total score 0-100, with higher scores indicating greater decisional conflict and worse decision-making outcomes).
Time frame
Administered by Research Assistant 1-6 weeks after a transition decision.Secondary outcomes
1
Decision Self-Efficacy
Measured using the Decision Self-Efficacy Scale (11 items; each rated 0-4, standardized to a 0-100 score, with higher scores indicating greater decision self-efficacy and better outcomes).
Time frame
Administered by Research Assistant 1-6 weeks after a transition decision and periodically thereafter.2
Transition Rate
Measured as the rate of hospital transitions during the pre- and post-intervention periods, including: (1) total number of transitions documented in electronic medical records; (2) avoidable transitions, defined as transitions for conditions that could have been managed in the LTC home (e.g., non-critical infections, falls without significant injury); and (3) repeat transitions, defined as multiple transitions experienced by the same resident within a 6-month period.
Time frame
Measured continuously during the 6 months pre-intervention and 6 months post-intervention periods.3
Resident Health Outcomes Post-Transition
Measured as the rate of rehospitalizations within 30 days of discharge among residents who experienced a hospital transition. This outcome will be assessed using electronic medical records, contingent on resident consent and feasibility of participant identification. Higher rates indicate worse health outcomes.
Time frame
Measured continuously during the 6 months pre-intervention and 6 months post-intervention periods.Sponsors and contacts
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Source ClinicalTrials.gov