Abstract
BackgroundResearch has highlighted the need for improving the implementation of advance care planning (ACP) in nursing homes. We developed a theory-based multicomponent ACP intervention (the ACP+ programme) aimed at supporting nursing home staff with the implementation of ACP into routine nursing home care. We describe here the protocol of a cluster randomised controlled trial (RCT) that aims to evaluate the effects of ACP+ on nursing home staff and volunteer level outcomes and its underlying processes of change.MethodsWe will conduct a cluster RCT in Flanders, Belgium. Fourteen eligible nursing homes will be pair-matched and one from each pair will be randomised to either continue care and education as usual or to receive the ACP+ programme (a multicomponent programme which is delivered stepwise over an eight-month period with the help of an external trainer). Primary outcomes are: nursing home care staff’s knowledge of, and self-efficacy regarding ACP. Secondary outcomes are: 1) nursing home care staff’s attitudes towards ACP and ACP practices; 2) support staff’s and volunteer’s ACP practices and 3) support staff’s and volunteers’ self-efficacy. Measurements will be performed at baseline and eight months post-measurement, using structured self-reported questionnaires. A process evaluation will accompany the outcome evaluation in the intervention group, with measurements throughout and post-intervention to assess implementation, mechanisms of impact and context and will be carried out using a mixed-methods design.DiscussionThere is little high-quality evidence regarding the effectiveness and underlying processes of change of ACP in nursing homes. This combined outcome and process evaluation of the ACP+ programme aims to contribute to building the necessary evidence to improve ACP and its uptake for nursing home residents and their family.Trial registrationThe study is registered at ClinicalTrials.gov (no. NCT03521206). Registration date: May 10, 2018. Inclusion of nursing homes started March, 2018. Hence, the trial was retrospectively registered but before end of data collection and analyses.
Highlights
Research has highlighted the need for improving the implementation of advance care planning (ACP) in nursing homes
Previous epidemiological studies have shown that uptake is low in Belgium where only half of deceased nursing home residents had documented wishes or preferences [7] and 38% of residents never engaged in ACP during their two-year stay in a nursing home [6]
To improve the uptake of ACP in regular nursing home practice, we have developed the ACP+ programme for nursing homes in Flanders (Belgium)
Summary
Research has highlighted the need for improving the implementation of advance care planning (ACP) in nursing homes. A number of previous studies in nursing home populations have shown that, if ACP is conducted, it can effectively decrease hospitalisation rates and hospital deaths, decrease overall health costs and increase treatment concordant with people’s wishes [3]. These findings usually do not come from studies using high-quality methodologies, as was identified in a recent systematic review using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria to assess the quality of the studies that had evaluated effects of ACP in nursing homes. Previous epidemiological studies have shown that uptake is low in Belgium where only half of deceased nursing home residents had documented wishes or preferences [7] and 38% of residents never engaged in ACP during their two-year stay in a nursing home [6]
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