Effects of a theory-based advance care planning intervention for nursing homes: A cluster randomized controlled trial

Lara Pivodic; Annelien Wendrich-van Dael; Joni Gilissen; Stefanie De Buyser; Luc Deliens; Chris Gastmans; Robert Vander Stichele; Lieve Van den Block

doi:10.1177/02692163221102000

Effects of a theory-based advance care planning intervention for nursing homes: A cluster randomized controlled trial

Lara Pivodic, Annelien Wendrich-van Dael, Joni Gilissen, Stefanie De Buyser, Luc Deliens, Chris Gastmans, Robert Vander Stichele, Lieve Van den Block

Family Medicine and Chronic Care

Research output: Contribution to journal › Article › peer-review

9 Citations (Scopus)

105 Downloads (Pure)

Abstract

BACKGROUND: Uptake of advance care planning in routine nursing home care is low. Through extensive literature review, theoretical development, and stakeholder involvement, we developed the ACP+ intervention.

AIMS: To evaluate the effects of ACP+ on the knowledge and self-efficacy (confidence in own skills) of nursing home care staff concerning advance care planning.

DESIGN: Cluster randomized controlled trial, conducted between February 2018 and January 2019 (NCT03521206, clinicaltrials.gov). ACP+ is a multicomponent intervention aimed at training and supporting nursing home staff and management in implementing advance care planning in nursing home practice through a train-the-trainer approach over 8 months. Fourteen nursing homes were randomized using a matched-pairing strategy, seven received ACP+, seven followed usual practice. Analyses (intention-to-treat) involved linear mixed models.

SETTING/PARTICIPANTS: Nursing homes in Flanders (Belgium).

RESULTS: 694 of 1017 care staff (68% response rate) at baseline and 491 of 989 care staff (50%) post-intervention (8 months) returned questionnaires. Post-intervention, care staff's self-efficacy concerning advance care planning was significantly higher in the intervention than in the control group (baseline-adjusted mean difference 0.57; 95% CI 0.20-0.94; p = 0.003; Cohen's d = 0.30). Advance care planning knowledge (95% CI 0.95-1.15; p = 0.339; ratio: 1.04) did not differ significantly between groups.

CONCLUSIONS: The ACP+ intervention for nursing homes improved care staff's self-efficacy but not their knowledge concerning advance care planning. Considering the comprehensive and multi-component approach used, these effects were smaller than expected. Reasons for this may be related to the chosen follow-up period, outcomes and measurements, or to the intervention itself and its implementation.

Original language	English
Pages (from-to)	1059-1071
Number of pages	13
Journal	Palliative Medicine
Volume	36
Issue number	7
DOIs	https://doi.org/10.1177/02692163221102000
Publication status	Published - Jul 2022

Bibliographical note

Funding Information:
The research team would like to thank all nursing home managers and staff for participating in this study, as well as trainers Katrien Cordemans and Harry Sorgeloos. We additionally thank all experts who were involved in the development of the ACP+ intervention; Liesbeth Van Humbeeck (UZ Gent) for reviewing intervention materials; Naomi Dhollander, Marc Tange, Kristel Paque, Charless Dupont, and Laura Neirinck for the pre-testing of our questionnaires; Prof. Herman Nys (KU Leuven) for checking that our questionnaire accurately represents Belgian medical law; Wilfried Cools (VUB) for conducting randomization; Zorgnet-Icuro, Ferubel, VLOZO/FOS, and VVSG, Flanders Centre for sharing their expertise concerning dementia; and DeMens.Nu and the Flemish Palliative Care Federation for their support in recruiting nursing homes into our study. We also thank the reviewers of this article for their valuable contributions and reflections. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the Research Foundation-Flanders (FWO) and the European Union’s Horizon 2020, Marie Skłodowska Curie Actions—Innovative Training Network program (under grant agreement no. 676265) and fonds wetenschappelijk onderzoek. LVdB holds the Francqui Research Professor Chair. LP is a Senior Postdoctoral Fellow of the Research Foundation-Flanders. The funders have no role in the design of the study and collection, analysis, and interpretation of data, in writing the manuscript, or in the decision to submit the manuscript for publication.

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the Research Foundation-Flanders (FWO) and the European Union’s Horizon 2020, Marie Skłodowska Curie Actions—Innovative Training Network program (under grant agreement no. 676265) and fonds wetenschappelijk onderzoek. LVdB holds the Francqui Research Professor Chair. LP is a Senior Postdoctoral Fellow of the Research Foundation-Flanders. The funders have no role in the design of the study and collection, analysis, and interpretation of data, in writing the manuscript, or in the decision to submit the manuscript for publication.

Publisher Copyright:
© The Author(s) 2022.

Copyright:
Copyright 2022 Elsevier B.V., All rights reserved.

Keywords

Advance Care Planning
Cluster Analysis
Humans
Nursing Homes
Nursing Staff
Surveys and Questionnaires

Access to Document

10.1177/02692163221102000

2022_PivodicL_PalliatMedAccepted author manuscript, 1.01 MBLicence: Other

Cite this

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title = "Effects of a theory-based advance care planning intervention for nursing homes: A cluster randomized controlled trial",

abstract = "BACKGROUND: Uptake of advance care planning in routine nursing home care is low. Through extensive literature review, theoretical development, and stakeholder involvement, we developed the ACP+ intervention.AIMS: To evaluate the effects of ACP+ on the knowledge and self-efficacy (confidence in own skills) of nursing home care staff concerning advance care planning.DESIGN: Cluster randomized controlled trial, conducted between February 2018 and January 2019 (NCT03521206, clinicaltrials.gov). ACP+ is a multicomponent intervention aimed at training and supporting nursing home staff and management in implementing advance care planning in nursing home practice through a train-the-trainer approach over 8 months. Fourteen nursing homes were randomized using a matched-pairing strategy, seven received ACP+, seven followed usual practice. Analyses (intention-to-treat) involved linear mixed models.SETTING/PARTICIPANTS: Nursing homes in Flanders (Belgium).RESULTS: 694 of 1017 care staff (68% response rate) at baseline and 491 of 989 care staff (50%) post-intervention (8 months) returned questionnaires. Post-intervention, care staff's self-efficacy concerning advance care planning was significantly higher in the intervention than in the control group (baseline-adjusted mean difference 0.57; 95% CI 0.20-0.94; p = 0.003; Cohen's d = 0.30). Advance care planning knowledge (95% CI 0.95-1.15; p = 0.339; ratio: 1.04) did not differ significantly between groups.CONCLUSIONS: The ACP+ intervention for nursing homes improved care staff's self-efficacy but not their knowledge concerning advance care planning. Considering the comprehensive and multi-component approach used, these effects were smaller than expected. Reasons for this may be related to the chosen follow-up period, outcomes and measurements, or to the intervention itself and its implementation.",

keywords = "Advance Care Planning, Cluster Analysis, Humans, Nursing Homes, Nursing Staff, Surveys and Questionnaires",

author = "Lara Pivodic and {Wendrich-van Dael}, Annelien and Joni Gilissen and {De Buyser}, Stefanie and Luc Deliens and Chris Gastmans and {Vander Stichele}, Robert and {Van den Block}, Lieve",

note = "Funding Information: The research team would like to thank all nursing home managers and staff for participating in this study, as well as trainers Katrien Cordemans and Harry Sorgeloos. We additionally thank all experts who were involved in the development of the ACP+ intervention; Liesbeth Van Humbeeck (UZ Gent) for reviewing intervention materials; Naomi Dhollander, Marc Tange, Kristel Paque, Charless Dupont, and Laura Neirinck for the pre-testing of our questionnaires; Prof. Herman Nys (KU Leuven) for checking that our questionnaire accurately represents Belgian medical law; Wilfried Cools (VUB) for conducting randomization; Zorgnet-Icuro, Ferubel, VLOZO/FOS, and VVSG, Flanders Centre for sharing their expertise concerning dementia; and DeMens.Nu and the Flemish Palliative Care Federation for their support in recruiting nursing homes into our study. We also thank the reviewers of this article for their valuable contributions and reflections. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the Research Foundation-Flanders (FWO) and the European Union{\textquoteright}s Horizon 2020, Marie Sk{\l}odowska Curie Actions—Innovative Training Network program (under grant agreement no. 676265) and fonds wetenschappelijk onderzoek. LVdB holds the Francqui Research Professor Chair. LP is a Senior Postdoctoral Fellow of the Research Foundation-Flanders. The funders have no role in the design of the study and collection, analysis, and interpretation of data, in writing the manuscript, or in the decision to submit the manuscript for publication. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the Research Foundation-Flanders (FWO) and the European Union{\textquoteright}s Horizon 2020, Marie Sk{\l}odowska Curie Actions—Innovative Training Network program (under grant agreement no. 676265) and fonds wetenschappelijk onderzoek. LVdB holds the Francqui Research Professor Chair. LP is a Senior Postdoctoral Fellow of the Research Foundation-Flanders. The funders have no role in the design of the study and collection, analysis, and interpretation of data, in writing the manuscript, or in the decision to submit the manuscript for publication. Publisher Copyright: {\textcopyright} The Author(s) 2022. Copyright: Copyright 2022 Elsevier B.V., All rights reserved.",

year = "2022",

month = jul,

doi = "10.1177/02692163221102000",

language = "English",

volume = "36",

pages = "1059--1071",

journal = "Palliative Medicine",

issn = "0269-2163",

publisher = "SAGE Publications Ltd",

number = "7",

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Effects of a theory-based advance care planning intervention for nursing homes : A cluster randomized controlled trial. / Pivodic, Lara; Wendrich-van Dael, Annelien; Gilissen, Joni; De Buyser, Stefanie; Deliens, Luc; Gastmans, Chris; Vander Stichele, Robert; Van den Block, Lieve.

In: Palliative Medicine, Vol. 36, No. 7, 07.2022, p. 1059-1071.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Effects of a theory-based advance care planning intervention for nursing homes

T2 - A cluster randomized controlled trial

AU - Pivodic, Lara

AU - Wendrich-van Dael, Annelien

AU - Gilissen, Joni

AU - De Buyser, Stefanie

AU - Deliens, Luc

AU - Gastmans, Chris

AU - Vander Stichele, Robert

AU - Van den Block, Lieve

N1 - Funding Information: The research team would like to thank all nursing home managers and staff for participating in this study, as well as trainers Katrien Cordemans and Harry Sorgeloos. We additionally thank all experts who were involved in the development of the ACP+ intervention; Liesbeth Van Humbeeck (UZ Gent) for reviewing intervention materials; Naomi Dhollander, Marc Tange, Kristel Paque, Charless Dupont, and Laura Neirinck for the pre-testing of our questionnaires; Prof. Herman Nys (KU Leuven) for checking that our questionnaire accurately represents Belgian medical law; Wilfried Cools (VUB) for conducting randomization; Zorgnet-Icuro, Ferubel, VLOZO/FOS, and VVSG, Flanders Centre for sharing their expertise concerning dementia; and DeMens.Nu and the Flemish Palliative Care Federation for their support in recruiting nursing homes into our study. We also thank the reviewers of this article for their valuable contributions and reflections. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the Research Foundation-Flanders (FWO) and the European Union’s Horizon 2020, Marie Skłodowska Curie Actions—Innovative Training Network program (under grant agreement no. 676265) and fonds wetenschappelijk onderzoek. LVdB holds the Francqui Research Professor Chair. LP is a Senior Postdoctoral Fellow of the Research Foundation-Flanders. The funders have no role in the design of the study and collection, analysis, and interpretation of data, in writing the manuscript, or in the decision to submit the manuscript for publication. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the Research Foundation-Flanders (FWO) and the European Union’s Horizon 2020, Marie Skłodowska Curie Actions—Innovative Training Network program (under grant agreement no. 676265) and fonds wetenschappelijk onderzoek. LVdB holds the Francqui Research Professor Chair. LP is a Senior Postdoctoral Fellow of the Research Foundation-Flanders. The funders have no role in the design of the study and collection, analysis, and interpretation of data, in writing the manuscript, or in the decision to submit the manuscript for publication. Publisher Copyright: © The Author(s) 2022. Copyright: Copyright 2022 Elsevier B.V., All rights reserved.

PY - 2022/7

Y1 - 2022/7

N2 - BACKGROUND: Uptake of advance care planning in routine nursing home care is low. Through extensive literature review, theoretical development, and stakeholder involvement, we developed the ACP+ intervention.AIMS: To evaluate the effects of ACP+ on the knowledge and self-efficacy (confidence in own skills) of nursing home care staff concerning advance care planning.DESIGN: Cluster randomized controlled trial, conducted between February 2018 and January 2019 (NCT03521206, clinicaltrials.gov). ACP+ is a multicomponent intervention aimed at training and supporting nursing home staff and management in implementing advance care planning in nursing home practice through a train-the-trainer approach over 8 months. Fourteen nursing homes were randomized using a matched-pairing strategy, seven received ACP+, seven followed usual practice. Analyses (intention-to-treat) involved linear mixed models.SETTING/PARTICIPANTS: Nursing homes in Flanders (Belgium).RESULTS: 694 of 1017 care staff (68% response rate) at baseline and 491 of 989 care staff (50%) post-intervention (8 months) returned questionnaires. Post-intervention, care staff's self-efficacy concerning advance care planning was significantly higher in the intervention than in the control group (baseline-adjusted mean difference 0.57; 95% CI 0.20-0.94; p = 0.003; Cohen's d = 0.30). Advance care planning knowledge (95% CI 0.95-1.15; p = 0.339; ratio: 1.04) did not differ significantly between groups.CONCLUSIONS: The ACP+ intervention for nursing homes improved care staff's self-efficacy but not their knowledge concerning advance care planning. Considering the comprehensive and multi-component approach used, these effects were smaller than expected. Reasons for this may be related to the chosen follow-up period, outcomes and measurements, or to the intervention itself and its implementation.

AB - BACKGROUND: Uptake of advance care planning in routine nursing home care is low. Through extensive literature review, theoretical development, and stakeholder involvement, we developed the ACP+ intervention.AIMS: To evaluate the effects of ACP+ on the knowledge and self-efficacy (confidence in own skills) of nursing home care staff concerning advance care planning.DESIGN: Cluster randomized controlled trial, conducted between February 2018 and January 2019 (NCT03521206, clinicaltrials.gov). ACP+ is a multicomponent intervention aimed at training and supporting nursing home staff and management in implementing advance care planning in nursing home practice through a train-the-trainer approach over 8 months. Fourteen nursing homes were randomized using a matched-pairing strategy, seven received ACP+, seven followed usual practice. Analyses (intention-to-treat) involved linear mixed models.SETTING/PARTICIPANTS: Nursing homes in Flanders (Belgium).RESULTS: 694 of 1017 care staff (68% response rate) at baseline and 491 of 989 care staff (50%) post-intervention (8 months) returned questionnaires. Post-intervention, care staff's self-efficacy concerning advance care planning was significantly higher in the intervention than in the control group (baseline-adjusted mean difference 0.57; 95% CI 0.20-0.94; p = 0.003; Cohen's d = 0.30). Advance care planning knowledge (95% CI 0.95-1.15; p = 0.339; ratio: 1.04) did not differ significantly between groups.CONCLUSIONS: The ACP+ intervention for nursing homes improved care staff's self-efficacy but not their knowledge concerning advance care planning. Considering the comprehensive and multi-component approach used, these effects were smaller than expected. Reasons for this may be related to the chosen follow-up period, outcomes and measurements, or to the intervention itself and its implementation.

KW - Advance Care Planning

KW - Cluster Analysis

KW - Humans

KW - Nursing Homes

KW - Nursing Staff

KW - Surveys and Questionnaires

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U2 - 10.1177/02692163221102000

DO - 10.1177/02692163221102000

M3 - Article

C2 - 35769038

VL - 36

SP - 1059

EP - 1071

JO - Palliative Medicine

JF - Palliative Medicine

SN - 0269-2163

IS - 7

ER -

Effects of a theory-based advance care planning intervention for nursing homes: A cluster randomized controlled trial

Abstract

Bibliographical note

Keywords

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SRP4: Strategic Research Programme: End-of-life in cancer and non-cancer patients: public health, health services and clinical research. Addressing present and future challenges in palliative care.

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Effects of a theory-based advance care planning intervention for nursing homes: A cluster randomized controlled trial

Abstract

Bibliographical note

Keywords

Access to Document

Other files and links

Fingerprint

Projects

SRP4: Strategic Research Programme: End-of-life in cancer and non-cancer patients: public health, health services and clinical research. Addressing present and future challenges in palliative care.

Cite this