STEP Toolkit for Hospital Admission Decisions

(STEP Trial)

Recruiting at 1 trial location

Overseen By Alixe Ménard, MSc, PhD(c)

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Bruyère Health Research Institute.

Disqualifiers: Under 55, Non-resident, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

300 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new tool called the STEP Decision Support Toolkit. It aims to assist residents in long-term care homes and their families in making better decisions about hospital transfers during health crises. The study will determine if this tool can reduce stress and improve confidence in decision-making for both residents and nursing staff. Individuals living in Perley Health or Bruyère Health Saint-Louis who speak French or English may be suitable participants. Nurses and other care workers involved in planning and managing health events at these homes can also join. As an unphased trial, this study provides a unique opportunity to contribute to innovative solutions that could enhance decision-making in healthcare settings.

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on decision-making tools rather than medication changes.

What prior data suggests that the STEP toolkit is safe for improving decision-making in hospital transfers?

Research has shown that decision support tools like the STEP toolkit are generally safe because they are not medical treatments. Instead, they assist people in making informed choices. These tools aim to enhance communication and decision-making, resulting in minimal risk of harm.

The STEP toolkit specifically aids in decisions about hospital transfers for long-term care residents. It includes a brochure and a decision-making guide to help residents and their care partners make choices aligned with their values. Nurses trained in using the STEP tool facilitate these discussions, ensuring the process remains supportive and clear.

While there is no direct "safety" concern as with a drug or medical procedure, the STEP toolkit is considered safe because it helps people make better decisions without introducing risks. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the STEP Decision Support Toolkit because it offers a fresh approach to decision-making in long-term care (LTC) settings. Unlike standard procedures, which often rely on ad-hoc decisions during acute medical events, the STEP toolkit provides a structured decision-making guide designed to be used at critical points in a resident's care journey. This method emphasizes shared decision-making and helps ensure that choices about hospital transfers are informed and aligned with the resident's values. By training LTC nurses to facilitate this process, the toolkit aims to empower residents and their care partners, potentially leading to more personalized and appropriate care decisions.

What evidence suggests that the STEP toolkit is effective for improving hospital transfer decisions?

Studies have shown that decision support tools can significantly enhance how patients and their care teams make health decisions together in long-term care settings. These tools foster teamwork in making important health choices. In this trial, participants will use the STEP Decision Support Toolkit, designed to aid shared decision-making about hospital transfers. Research indicates that tools like the STEP Decision Support Toolkit can reduce uncertainty and increase confidence in hospital transfer decisions. Previous findings suggest that well-trained nurses using these tools feel more confident in their roles and improve the quality of their documentation. Overall, the STEP toolkit aims to make decision-making clearer and less stressful for everyone involved. ^{3 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for long-term care residents who may face decisions about hospital transfers, including those with frailty or cognitive impairment. It's also for their decision-makers and nursing staff involved in care planning. People are excluded if they don't meet the specific conditions required by the study.

Inclusion Criteria

My decision-maker will participate on my behalf because I'm unable to.

Residents-care partner dyads must be residents of either Perley Health or Bruyère Health Saint-Louis LTC home

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

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Vanguard Phase

Initial vanguard phase involving approximately ten residents to test feasibility and refine recruitment

4-6 weeks

Pre-Intervention Data Collection

Data collected for three months or until target sample size is reached before the intervention

12 weeks

Intervention

Implementation of the STEP tool at two LTC sites, with training for staff and use during key care planning moments

6 months

Follow-up

Participants are monitored for decision-making outcomes and health impacts post-intervention

6 months

What Are the Treatments Tested in This Trial?

Interventions

• STEP Decision Support Toolkit

Trial Overview The STEP Decision Support Toolkit is being tested to see if it helps with making better decisions about when to transfer long-term care residents to hospitals. The study will look at whether it reduces uncertainty and regret around these decisions and boosts nurses' confidence.

How Is the Trial Designed?

Group I: STEP Intervention Experimental Treatment 1 Intervention

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 a brochure and structured decision-making guide 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.

Who Is Running the Clinical Trial?

Bruyère Health Research Institute.

Lead Sponsor

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9490521/

Decision Support Tools in Adult Long-term Care Facilities The aim of this review was to analyze studies that evaluated clinical decision support tools in long-term care facilities based on the purpose and intended ...

2. jmir.org jmir.org/2025/1/e59956/

Shared Decision-Making Tools Implemented in the ... Shared decision-making (SDM) is a model of patient-centered care that encourages patients and clinicians to work together to reach medical ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S0738399124001344

Technology-supported shared decision-making in chronic ... This approach includes shared decision making (SDM), a collaborative process between a patient and a HCP to decide on the best treatment option, where among ...

4. researchgate.net researchgate.net/publication/340068855_Strategies_to_facilitate_shared_decision-making_in_long-term_care

(PDF) Strategies to facilitate shared decision-making in ... Aim The aim of this study was to explore shared decision‐making among residents, their families and staff to determine relevant strategies to support shared ...

5. nam.edu nam.edu/perspectives/shared-decision-making-strategies-for-best-care-patient-decision-aids/

Shared Decision-Making Strategies for Best Care: Patient ... The study found that health care practitioners made a recommendation 8 out of 10 times and that the clinician recommendation most often favored the intervention ...

6. trialx.com trialx.com/clinical-trials/listings/308344/evaluation-of-the-step-intervention-for-long-term-care-residents-facing-hospital-transfer-decisions/

Evaluation of the STEP Intervention for Long-Term Care ... This trial will evaluate whether the Supporting Transitions and Empowering Preferences (STEP) toolkit can improve decision-making about hospital transfers in ...

7. ahrq.gov ahrq.gov/teamstepps-program/curriculum/situation/tools/step.html

Tool: STEP | Agency for Healthcare Research and Quality STEP is a mnemonic tool that can help individuals monitor critical elements of a situation and the overall environment.

8. sciencedirect.com sciencedirect.com/science/article/pii/S2772442523001156

A comprehensive and integrated hospital decision support ... We developed a whole hospital-level decision support system to assess and respond to the needs of local populations.

9. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8175645/

Developing a Data-Driven Approach in Order to Improve ... Abstract. Objective: To improve the safety and quality of patient care in hospitals by shaping clinical pathways throughout the patient journey.