An interventional study of STEP Decision Support Toolkit in LTC-to-hospital Transfer Decision-making, sponsored by Bruyère Health Research Institute.. Recruiting at 2 sites in Canada. Open to participants aged 55 Years and older. Per ClinicalTrials.gov, last updated 2026-02-06.
Sponsored by Bruyère Health Research Institute. · Not applicable, Interventional, and Health services research
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:
Participants will:
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.
Background and Rationale: Transitions from long-term care (LTC) to hospital are complex and can offer both benefits and challenges to residents and care partners. While LTC-to-hospital transitions can improve health outcomes, particularly during acute deterioration, evidence also indicates that these transitions may disrupt continuity of care, increase stress, and misalign resident needs with hospital protocols. Nearly fifty percent of LTC residents in Canada experience hospital transitions annually, with approximately forty percent considered avoidable. Risks include non-evidence-based care, safety concerns, unnecessary interventions, and increased mortality rates. Transition decisions are influenced by residents' health status, medico-legal concerns, staff workload, and care partners' confidence in LTC care. These decisions are often reactive and shaped by unequal power dynamics rather than proactive, collaborative planning.
Given these challenges, and limitations in current monitoring systems such as the Minimum Data Set assessments, there is a critical need for a decision aid that supports informed, resident-centered planning. The Supporting Transitions and Empowering Preferences (STEP) tool was developed through interviews, co-design sessions, document analysis, and stakeholder engagement.
Objectives Primary Objective: Evaluate the impact of STEP on decisional conflict among residents and care partners.
Secondary Objective: Examine the effect of STEP on nurses' self-efficacy as decision coaches at the time of transition decisions.
Trial Design and Study Setting: A pre-post evaluation will be conducted at two LTC sites (Perley Health and Bruyère Health Saint-Louis LTC) to assess STEP's ability to support resident-care partner dyads in making hospital transition decisions. STEP will be implemented simultaneously at both sites.
Study Overview: Data will be collected for six months pre-intervention or until the target sample size is reached (n=100), followed by the intervention period. Nurses, nurse practitioners, social service workers, and physicians will receive STEP training, with designated champions supporting implementation. Data will be collected at three points: after intake/admission meetings, after care conferences, and after acute events in which a transfer is considered.
Vanguard Phase Implementation: An initial vanguard phase involving approximately ten residents over four to six weeks will test feasibility, refine recruitment, and assess staff comfort before broader rollout.
Description of the Intervention (Overview): The STEP intervention includes three resources: (1) an educational booklet about transition decisions, (2) a structured decision aid, and (3) a phone script for nursing staff calling substitute decision-makers at the time of a transfer decision. Staff will be trained on the use of these resources with sessions scheduled to accommodate different shifts. STEP will be introduced at admission (educational booklet), reviewed at post-admission or annual care conferences (booklet + decision aid), and used during acute health events (decision aid + phone script) to guide structured conversations about hospital transfer decisions.
Monitoring Fidelity: Implementation fidelity will be monitored through nurse logs, informal discussions, and champion reports, assessing feasibility, acceptability, and adherence.
Data Collection Procedures (Overview): Dyads will be identified through care reports and hospital transfer notifications, with eligibility verified prior to consent. Data will be collected using secure REDCap software. For nurses, care conference and physician call notes will be reviewed to identify eligible cases. Surveys and brief interviews will assess experiences, confidence, and barriers to STEP use.
Analysis: Analyses will follow an intention-to-treat approach using Generalized Estimating Equations for repeated measures. Differences between groups will be examined using t-tests or chi-squared tests. Missing data will be minimized through follow-up; cases lost after three unsuccessful contact attempts will be excluded from analysis.
1,284 studies on the registry are indexed under Frailty; 452 are open to participants now.
This study's planned enrollment of 200 is above the median of 81 across 767 interventional studies indexed under Frailty.
Browse Frailty studies →Bruyère Health Research Institute. is the lead sponsor of 9 studies on the registry; 6 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Inclusion Criteria
Residents-care partner dyads:
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:
Participants (resident-care partner dyads) in this arm will receive the STEP intervention. STEP is a decision aid designed to support shared decision-making about whether to transfer to hospital or remain in LTC during acute health events. It includes an educational booklet, a structured decision aid, and a staff phone script used at three points in the resident's care journey: (1) upon LTC admission, (2) during annual care conferences, and (3) at the time of an acute medical event. LTC nurses will receive training to deliver the STEP tool and support residents and care partners in making informed, values-based transition decisions.
Behavioral: STEP Decision Support Toolkit
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.
Decisional Conflict
Measured using the Decisional Conflict Scale (16 items; each rated on a 5-point scale; standardized total score 0-100, with higher scores indicating greater decisional conflict and worse decision-making outcomes).
Time frame: Administered by Research Assistant 1-6 weeks after a transition decision.
Decision Self-Efficacy
Measured using the Decision Self-Efficacy Scale (11 items; each rated 0-4, standardized to a 0-100 score, with higher scores indicating greater decision self-efficacy and better outcomes).
Time frame: Administered by Research Assistant 1-6 weeks after a transition decision and periodically thereafter.
Transition Rate
Measured as the rate of hospital transitions during the pre- and post-intervention periods, including: (1) total number of transitions documented in electronic medical records; (2) avoidable transitions, defined as transitions for conditions that could have been managed in the LTC home (e.g., non-critical infections, falls without significant injury); and (3) repeat transitions, defined as multiple transitions experienced by the same resident within a 6-month period.
Time frame: Measured continuously during the 6 months pre-intervention and 6 months post-intervention periods.
Resident Health Outcomes Post-Transition
Measured as the rate of rehospitalizations within 30 days of discharge among residents who experienced a hospital transition. This outcome will be assessed using electronic medical records, contingent on resident consent and feasibility of participant identification. Higher rates indicate worse health outcomes.
Time frame: Measured continuously during the 6 months pre-intervention and 6 months post-intervention periods.
Plan to share: No — Given the small sample size, the sensitive nature of data collected in long-term care settings, and the potential risk of participant re-identification, we do not plan to share IPD publicly. However, IPD may be shared on a case-by-case basis in response to reasonable, ethically approved requests. Aggregate results will be disseminated through publications and presentations.
Started Oct 2025 (actual). Primary completion is estimated for Mar 2026, 5 months after the start.
Of 513 non-industry interventional studies with no phase under Frailty, half reached primary completion within 22 months of starting (the median), counting those still running; a quarter within 11 and three quarters within 39. This study's planned 5 months is below that.
Counting every sponsor, half of 517 studies reached it within 22 months; a quarter within 10 and three quarters within 39.
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