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

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)1059-1071
Number of pages13
JournalPalliative Medicine
Volume36
Issue number7
DOIs
Publication statusPublished - Jul 2022

Keywords

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

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