Abstract
BackgroundCurrently, health care and medical decision-making at the end of life for older people are often insufficiently patient-centred. In this trial we study the effects of Advance Care Planning (ACP), a formalised process of timely communication about care preferences at the end of life, for frail older people.Methods/DesignWe will conduct a cluster randomised controlled trial among older people residing in care homes or receiving home care in the Netherlands. The intervention group will receive the ACP program Respecting Choices® in addition to usual care. The control group will receive usual care only. Participants in both groups will fill out questionnaires at baseline and after 12 months. We hypothesize that ACP will lead to better patient activation in medical decision making and quality of life, while reducing the number of medical interventions and thus health care costs. Multivariate analysis will be used to compare differences between the intervention group and the control group at baseline and to compare differences in changes after 12 months following the inclusion.DiscussionOur study can contribute to more understanding of the effects of ACP on patient activation and quality of life in frail older people. Further, we will gain insight in the costs and cost-effectiveness of ACP. This study will facilitate ACP policy for older people in the Netherlands.Trial registrationNederlands Trial Register: NTR4454.
Highlights
Health care and medical decision-making at the end of life for older people are often insufficiently patient-centred
Our study can contribute to more understanding of the effects of Advance Care Planning (ACP) on patient activation and quality of life in frail older people
We focus on older people living in care homes or living at home and receiving home care
Summary
Health care and medical decision-making at the end of life for older people are often insufficiently patient-centred. To enable countries to successfully manage the dynamics and health care costs of their ageing populations, the WHO has proposed an “active ageing approach”, based on the United Nations Principles of independence, participation, dignity, care and self-fulfillment [1]. It targets government decisionmakers at all levels, the nongovernmental sector and the private sector, all of whom are responsible for the Advance Care Planning (ACP) is a formalised process of communication between patients, their relatives and professional caregivers about patients’ health preferences, goals and choices [3]. Written advance directives extend the autonomy of patients to a phase when they are incompetent [4]
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