“Help with rowing the boat”: Implementing and evaluating the Strengthening a Palliative Approach in Long-Term Care program in four Canadian provinces

Sharon Kaasalainen; Genevieve Thompson; Lynn McCleary; Lorraine Venturato; Abigail Wickson-Griffiths; Paulette V. Hunter; Tamara Sussman; Donny Li; Shane Sinclair; Thomas Hadjistavropoulos; Noori Akhtar-Danesh; Valerie Bourgeois-Guerin; Deborah Parker

doi:10.1177/26323524251369121

“Help with rowing the boat”: Implementing and evaluating the Strengthening a Palliative Approach in Long-Term Care program in four Canadian provinces

Sharon Kaasalainen, Genevieve Thompson, Lynn McCleary, Lorraine Venturato, Abigail Wickson-Griffiths, Paulette V. Hunter, Tamara Sussman, Donny Li, Shane Sinclair, Thomas Hadjistavropoulos, Noori Akhtar-Danesh, Valerie Bourgeois-Guerin, Deborah Parker

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Despite high mortality rates in long-term care (LTC), LTC homes continue to struggle to implement a palliative approach to care. Objectives: 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. Design: 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. Methods: Quantitative and qualitative data were collected whereby the qualitative component was used to help explain or elaborate on the main quantitative components. Results: 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. Conclusion: 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.

Original language	English
Article number	26323524251369121
Journal	Palliative Care and Social Practice
Volume	19
DOIs	https://doi.org/10.1177/26323524251369121
Publication status	Published - 1 Jan 2025
Externally published	Yes

Bibliographical note

Publisher Copyright:
© The Author(s) 2025. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Keywords

dementia
end-of-life care
family caregiver
long-term care
palliative approach
palliative care

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10.1177/26323524251369121

Cite this

Kaasalainen, S., Thompson, G., McCleary, L., Venturato, L., Wickson-Griffiths, A., Hunter, P. V., Sussman, T., Li, D., Sinclair, S., Hadjistavropoulos, T., Akhtar-Danesh, N., Bourgeois-Guerin, V., & Parker, D. (2025). “Help with rowing the boat”: Implementing and evaluating the Strengthening a Palliative Approach in Long-Term Care program in four Canadian provinces. Palliative Care and Social Practice, 19, Article 26323524251369121. https://doi.org/10.1177/26323524251369121

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title = "“Help with rowing the boat”: Implementing and evaluating the Strengthening a Palliative Approach in Long-Term Care program in four Canadian provinces",

abstract = "Background: Despite high mortality rates in long-term care (LTC), LTC homes continue to struggle to implement a palliative approach to care. Objectives: 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. Design: 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. Methods: Quantitative and qualitative data were collected whereby the qualitative component was used to help explain or elaborate on the main quantitative components. Results: 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. Conclusion: 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.",

keywords = "dementia, end-of-life care, family caregiver, long-term care, palliative approach, palliative care",

author = "Sharon Kaasalainen and Genevieve Thompson and Lynn McCleary and Lorraine Venturato and Abigail Wickson-Griffiths and Hunter, {Paulette V.} and Tamara Sussman and Donny Li and Shane Sinclair and Thomas Hadjistavropoulos and Noori Akhtar-Danesh and Valerie Bourgeois-Guerin and Deborah Parker",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).",

year = "2025",

month = jan,

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doi = "10.1177/26323524251369121",

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Kaasalainen, S, Thompson, G, McCleary, L, Venturato, L, Wickson-Griffiths, A, Hunter, PV, Sussman, T, Li, D, Sinclair, S, Hadjistavropoulos, T, Akhtar-Danesh, N, Bourgeois-Guerin, V & Parker, D 2025, '“Help with rowing the boat”: Implementing and evaluating the Strengthening a Palliative Approach in Long-Term Care program in four Canadian provinces', Palliative Care and Social Practice, vol. 19, 26323524251369121. https://doi.org/10.1177/26323524251369121

TY - JOUR

T1 - “Help with rowing the boat”

T2 - Implementing and evaluating the Strengthening a Palliative Approach in Long-Term Care program in four Canadian provinces

AU - Kaasalainen, Sharon

AU - Thompson, Genevieve

AU - McCleary, Lynn

AU - Venturato, Lorraine

AU - Wickson-Griffiths, Abigail

AU - Hunter, Paulette V.

AU - Sussman, Tamara

AU - Li, Donny

AU - Sinclair, Shane

AU - Hadjistavropoulos, Thomas

AU - Akhtar-Danesh, Noori

AU - Bourgeois-Guerin, Valerie

AU - Parker, Deborah

N1 - Publisher Copyright: © The Author(s) 2025. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

PY - 2025/1/1

Y1 - 2025/1/1

N2 - Background: Despite high mortality rates in long-term care (LTC), LTC homes continue to struggle to implement a palliative approach to care. Objectives: 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. Design: 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. Methods: Quantitative and qualitative data were collected whereby the qualitative component was used to help explain or elaborate on the main quantitative components. Results: 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. Conclusion: 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.

AB - Background: Despite high mortality rates in long-term care (LTC), LTC homes continue to struggle to implement a palliative approach to care. Objectives: 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. Design: 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. Methods: Quantitative and qualitative data were collected whereby the qualitative component was used to help explain or elaborate on the main quantitative components. Results: 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. Conclusion: 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.

KW - dementia

KW - end-of-life care

KW - family caregiver

KW - long-term care

KW - palliative approach

KW - palliative care

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M1 - 26323524251369121

ER -

“Help with rowing the boat”: Implementing and evaluating the Strengthening a Palliative Approach in Long-Term Care program in four Canadian provinces

Abstract

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Keywords

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