Evaluation of the STEP Intervention for Long-Term Care Residents Facing Hospital Transfer Decisions
A Pre-Post Trial Evaluating the Supporting Transitions and Empowering Preferences (STEP) Decision Support Intervention for Long-Term Care Residents Facing Hospital Transfer Decisions During Acute Health Crises
Bruyère Health Research Institute.
200 participants
Oct 1, 2025
INTERVENTIONAL
Conditions
Summary
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
Inclusion Criteria10
- Residents-care partner dyads:
- 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.
- Both members of the dyad will be included where applicable. For dyads in which residents do not have the capacity to participate, inclusion will occur through the involvement of their substitute decision-maker (e.g., power of attorney for personal care).
- LTC staff:
- 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.
- Must have been employed at the LTC home for at least 6 months to ensure familiarity with the care environment and residents.
- Must play a role in facilitating discussions, providing clinical input (where applicable), or guiding decision-making processes related to hospital transitions or acute care management.
- Must be able to communicate in French or English.
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Interventions
The 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.
Locations(2)
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NCT07153341