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Implementation and evaluation of a mortality-risk prognostication tool (RESPECT-LTC) to enhance goals of care discussion in long-term care homes

Project status
Amy Hsu
Institution web page
Host institution
Bruyere Research Institute
Team members
Amy Hsu, Justin Presseau, Benoit Robert, Douglas Manuel, Peter Tanuseputro, Melissa Donskov, Kednapa Thavorn, Zsofia Orosz, Celeste Fung, Amit Arya, Claudia Hampel, Dawn Stacey, Aleksandra Grzeszczuk, Andre Carrington, Kanwal Abdul Hai, Lysanne Lessard
Funding information (if funded)
This project was funded by the Canadian Institutes of Health Research.
Project Summary

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. Among newly-admitted residents to long-term care (LTC) homes, where median life expectancy is just 18 months, most receiving care in this setting have limited life expectancy and can benefit from palliative care. 

In this project, we will adopt an implementation science approach to evaluate the use of 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 decision-making regarding the initiation of palliative and end-of-life care. 

Outputs / Expected Outputs

The research will be completed by December 2021 and expected outputs are: 

  • Qualitative evidence on the acceptability to the use prognostic tools to aid decision-making around palliative care needs in long-term care 
  • Identified barriers to the implementation of prognostic tools to support goals of care discussions within long-term care 
  • The number of residents in long-term care homes who had: (a) a risk assessment performed using RESPECT–LTC (out of all the residents at each home); (b) a care conference or goals of care conversation in which RESPECT–LTC results were discussed, and the care decisions that precipitated from the discussion (e.g., on hospital transfers, resuscitation, mechanical ventilation, and preferred location of death); and (c) received palliative care over a six-month period following the implementation of RESPECT–LTC. 
  • Healthcare outcomes associated with the use of RESPECT–LTC, such as a reduction in potentially burdensome transitions (i.e., frequent or unnecessary transfers to the emergency room and hospital), aggressive care at the end of life (e.g., intensive care unit [ICU] admissions, resuscitation, mechanical ventilation), health care cost, or misalignment between expressed preference for and recorded location of death among residents who died within one year of our implementation. 
  • A set of recommended clinical pathways based on prognostic information and risk groups generated from RESPECT–LTC to support equitable access to care for residents near the end of life. 
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Implementation and evaluation of a mortality-risk prognostication tool (RESPECT-LTC) to enhance goals of care discussion in long-term care homes