Kaasalainen Sharon, Thompson Genevieve, McCleary Lynn, Venturato Lorraine, Wickson-Griffiths Abigail, Hunter Paulette V, Sussman Tamara, Li Donny, Sinclair Shane, Hadjistavropoulos Thomas, Akhtar-Danesh Noori, Bourgeois-Guerin Valerie, Parker Deborah
School of Nursing, McMaster University, Hamilton, ON, Canada.
College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Palliat Care Soc Pract. 2025 Sep 7;19:26323524251369121. doi: 10.1177/26323524251369121. eCollection 2025.
Despite high mortality rates in long-term care (LTC), LTC homes continue to struggle to implement a palliative approach to care.
The objective of this research was to implement and evaluate the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC; www.spaltc.ca) program. Specifically, we explored its feasibility, acceptability, and preliminary effects on resident comfort, use of emergency department at end-of-life (EOL), and location of resident death.
This study used an explanatory mixed method design in four LTC homes; one in each of four provinces (Ontario, Manitoba, Saskatchewan, Alberta) in Canada to assess acceptability, feasibility, and preliminary effects of the program.
Quantitative and qualitative data were collected whereby the qualitative component was used to help explain or elaborate on the main quantitative components.
Of the 102 participating residents, 74.5% (76/102) had a Palliative Care Conference (PCC). However, of those who died, only 68.8% of them had a PCC. Rates of hospital use were reduced for study participants in terms of emergency department visits at EOL (relative risk reduction (RRR): 46%; 95% CI: -1.12, -0.10) and hospital deaths (RRR: 88%; 95% CI: -4.06, -1.12) compared to baseline. However, there were no significant differences in resident comfort. Family members stated that the PCCs were informative and thought that good communication was critical in providing quality care. They highlighted that close relationships and mutual respect among staff, residents, and families led to more meaningful care while the resident was alive as well as into bereavement. Staff stated that they found the SPA-LTC resources helpful and recognized the importance of having strong leadership using a Palliative Champion Team.
The SPA-LTC program appears to be feasible on some key activities and supports a family-centered approach to care, which relies on strong communication. Future research is needed to confirm these initial results.
尽管长期护理（LTC）中的死亡率很高，但长期护理机构仍在努力实施姑息治疗方法。
本研究的目的是实施并评估长期护理中的强化姑息治疗方法（SPA-LTC；www.spaltc.ca）项目。具体而言，我们探讨了其可行性、可接受性以及对居民舒适度、临终时急诊科的使用情况和居民死亡地点的初步影响。
本研究在四个长期护理机构中采用了解释性混合方法设计；加拿大四个省份（安大略省、曼尼托巴省、萨斯喀彻温省、艾伯塔省）各有一个机构，以评估该项目的可接受性、可行性和初步效果。
收集了定量和定性数据，其中定性部分用于帮助解释或详细说明主要的定量部分。
在102名参与研究的居民中，74.5%（76/102）参加了姑息治疗会议（PCC）。然而，在那些去世的居民中，只有68.8%的人参加了PCC。与基线相比，研究参与者在临终时的急诊科就诊次数（相对风险降低（RRR）：46%；95%置信区间：-1.12，-0.10）和医院死亡人数（RRR：88%；95%置信区间：-4.06，-1.12）方面的医院使用率有所降低。然而，居民舒适度方面没有显著差异。家庭成员表示，姑息治疗会议提供了丰富的信息，并认为良好的沟通对于提供优质护理至关重要。他们强调，工作人员、居民和家庭之间密切的关系和相互尊重会在居民生前以及丧亲期间带来更有意义的护理。工作人员表示，他们发现SPA-LTC资源很有帮助，并认识到通过姑息治疗冠军团队发挥强有力领导作用的重要性。
SPA-LTC项目在一些关键活动上似乎是可行的，并支持以家庭为中心的护理方法，这种方法依赖于强有力的沟通。需要进一步的研究来证实这些初步结果。
