Implementing a risk communication tool to support care planning conversations in long-term care: evaluation of...

Embedding a palliative approach into long-term care (LTC) homes can be hindered by poor communication around prognosis and an individual's personal wishes and goals for care. Risk Evaluation for Support: Predictions for Elder life in their Communities Tool (RESPECT) is a risk communication tool that supports earlier identification of palliative care needs. When paired with established resources like the Serious Illness Conversation (SIC) Guide, these tools have the potential to enable more timely, higher-quality goals-of-care conversations in LTC. We sought to evaluate training provided to healthcare providers during the implementation of RESPECT and the SIC Guide in LTC homes in Ontario, Canada.

Pre-post surveys were administered to healthcare providers in LTC who participated in co-administered RESPECT and SIC Guide training. Training evaluation surveys were developed using the Theoretical Domains Framework (TDF) to measure healthcare providers' ability to perform two palliative care behaviours: identifying residents earlier for a palliative approach and capturing goals of care discussions. Surveys were conducted before training, immediately after training, and 6 months post-training.

Three Ontario LTC homes took part, with 35 individual participants comprised mostly of physicians (29%) and nurses (51%). While 97% felt palliative care could benefit their residents before training (TDF domain: beliefs about consequences), few felt skilled (43%) and knowledgeable (69%) enough to do this (TDF domains: skills and knowledge). Immediately post-training and 6 months after implementation, skills (post-training: 83%; 6-month: 100%) and knowledge (post-training: 100%; 6-month: 100%) improved substantively. However, six months after training, only 58% felt they had a plan in place to identify residents earlier for palliative care (TDF domain: behavioural regulation), suggesting that behavioural regulation may be a potential barrier. Only 41% felt they received positive reinforcement for doing this behaviour well (TDF domain: reinforcement), and 91% felt competing demands (TDF domain: goals) could act as barriers to sustained practice.

Trained staff reported substantial improvements in their skills and knowledge in identifying residents earlier for a palliative approach and capturing goals-of-care discussions. However, environmental barriers, lack of behavioural regulation, and lack of positive reinforcement may impede sustained practice.