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
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 improve preparation for decision-making during acute health crises? * Does it reduce decisional conflict and regret in residents and care partners following these crises? * Does it improve nurse self-efficacy and documentation quality related to hospital transfer decisions? Participants will: * Use the STEP tool during key moments of care planning (admission, care conferences, and acute events) * Complete short surveys measuring their preparedness, decisional conflict, and regret * 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 and documentation related to hospital transfers.
⁃ 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.