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Recruiting NCT06090240

Motivational Interviewing to Enhance Advance Care Planning for Older Adults and Caregivers After Emergency Visits

No phase Interventional Older Adults Advance Care Planning Advance Directives Family Members

For patients and families

In plain language

An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.

What is being studied
The protocol lists: Dyadic MI-ACP intervention, Elderly alone MI-ACP.
Who it may be relevant to
Registry conditions: Older Adults, Advance Care Planning, Advance Directives, Family Members. Basic parameters: No limits · All.
What needs checking
Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
Where it takes place
Hong Kong
Next step
Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →

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Official title

Maximizing Teachable Moments: Motivational Interviewing (MI) to Enhance Advance Care Planning (ACP) for Older Adults and Caregivers After Emergency Visits - A Mixed-Method Randomized Controlled Trial

Overview

This study aims to evaluate the effectiveness of a motivational interviewing (MI) intervention in enhancing advance care planning (ACP) among older adults who have visited the Emergency Room (ER) in the past six months and their family caregivers. The main question it aims to answer is: The effectiveness of the MI-based ACP intervention implemented within six months of an ER visit on improving older adults' advance directives (AD) completion rate. Compared to participants in the control group who will only receive a self-education booklet, participants in the intervention group will receive a motivational interview educational intervention to see the effectiveness of an MI-based ACP intervention implemented within six months following an emergency room visit regarding the completion of AD for older adults.

Detailed description

Targeted issue: At present no feasible method exists to empower older adults following ER visits to engage in ACP in Hong Kong.

Population: The target group will be dyads comprising older adults who have had ER visits within the previous six months and their family caregivers.

Intervention: An MI-based ACP intervention our team developed.

Main study aim: To investigate the effectiveness of an MI-based ACP intervention implemented within six months following an emergency room visit on completion of AD for older adults compared to a self-education group.

Study method: Investigators will recruit eligible participants from two largest public hospitals, including the geriatric outpatient clinic of Queen Mary Hospital (IRB Ref: UW23-402) and the accident \& emergency department of Queen Elizabeth Hospital (IRB Ref: KC/KE-23-0058/ER-1). A parallel RCT (allocation ratio= 1:1) with a post-trial qualitative study will be adopted and three follow-up time points at 3-, 6- and 12-month post-intervention. Participants in the intervention group will receive a dyadic motivational interview educational intervention, while participants in the comparison group will receive the pictorial ACP educational booklet for self-learning only. Patients unable to nominate a family caregiver will receive the elderly alone motivational interview educational intervention. Completion of AD and health service utilization will be assessed at three follow-up time points. In addition, a post-intervention interview, regarding stakeholders' views on the relevance, effectiveness, and experience of the intervention., will be conducted.

Interventions

  • Behavioral Dyadic MI-ACP intervention
    Motivational Interviewing on Advance Care Planning Intervention: Dyads of older adults and family caregivers will receive three MI-based ACP counselling sessions: (1) a preparatory session, (2) motivation session, and (3) planning session. The preparatory session will take 10-15 minutes, and the following two sessions in weeks 2 and 3 will last 30-45 minutes each. Before each session, the nurse interventionist will first assess the dyad's readiness to engage in ACP based on the state of change a
  • Behavioral Elderly alone MI-ACP
    Older adults in this arm will receive an MI-based education intervention our team developed.

Primary outcome measures

  • Older adults' readiness for ACP [Time frame: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.]
Secondary outcome measures (8)
  • Family caregivers' readiness for ACP [Time frame: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.]
  • Older adults' emotional perception of ACP [Time frame: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.]
  • Older adults' and family caregivers' decisional conflict [Time frame: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.]
  • Older adults and family caregivers' congruence in goal of EOL care [Time frame: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.]
  • Older adults' completion of AD documentation [Time frame: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months(T3) post intervention .]
  • Older adults' health service utilization [Time frame: 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.]
  • Older adults' and family caregivers' baseline characteristics [Time frame: before the intervention (T0)]
  • Older adults and family caregivers' experience with the Nurse Navigation Program [Time frame: 3-month (T1) post intervention]

Eligibility criteria

The target group will be dyads comprising older adults who have had ER visits within the previous six months and their family caregivers. A dyad is defined as one older adult and one primary family caregiver of the older adult.

For older adults:

Inclusion criteria

  • Aged 65 or older
  • At least one episode of ER visit in the last six months
  • Has a family caregiver to be present during the intervention
  • Able to communicate in Chinese

Exclusion criteria

  • Has completion of an AD
  • Moderate to severe cognitive impairment or diagnosis of dementia, as identified in health records
  • Communication problems (e.g., deafness or aphasia)

For family caregivers:

Inclusion criteria

  • Aged 18 or above
  • Immediate or extended family member or friend nominated by an eligible older adult participant as primary caregiver
  • Able to communicate in Chinese

Exclusion criteria

  • Moderate to severe cognitive impairment
  • Communication problems (e.g., deafness or aphasia)

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation
Randomized
Model
Parallel assignment
Masking
Single blind
Primary purpose
Other

Study locations

Hong Kong · 1 center
  • University of Hong Kong, School of Nursing — Hong Kong

Identifiers

NCT: NCT06090240 · IRB-2023-150, HKWC-2023-342

Primary sources (government registries)

View this study on ClinicalTrials.gov ↗