“Now we Talk About it”: A Mixed-Methods Study of a Multilayered Palliative Care Educational Intervention in Long-Term Care Homes in New Brunswick

Background Long-term care (LTC) homes are increasingly the final place of care for older adults, many with life-limiting conditions, yet many lack a formalized palliative approach to care. Purpose We aimed to evaluate the potential impact of a multi-layered educational intervention based on the Strengthening a Palliative Approach to Care in LTC model on individual and organizational capacity for a palliative approach in LTC homes. Methods A mixed-methods design was used. Staff from 61/73 LTC homes engaged in the intervention to become Palliative Care Champions. Pre-post survey data were analyzed for Champions ( n = 33–41), and seven participated in post-intervention interviews. Quantitative data were analyzed using paired t-tests, Wilcoxon signed-rank and McNemar tests. Qualitative data were analyzed using thematic analysis. Results Significant improvements were reported at the individual level, including patient/family-centred communication ( p < .001), comfort with cultural and ethical values ( p < .001), and preparedness for palliative care ( p < .001). At the organizational level, formal palliative programs increased significantly (25.0% to 93.8%, p < .001) and active implementation of both a standardized functional assessment tool and a Champion Team, increased from 32.4% to 73.5% ( p = .001). Qualitative findings revealed two key themes: confidence through education and catalyzing culture change. Conclusions The multi-layered intervention was associated with improvements in staff and organizational capacity for a palliative approach in LTC. Findings highlight the value of structured education, mentorship, and leadership development to build capacity in LTC systems. Ongoing investment in implementation supports and communities of practice is recommended.