Implementing a Nurse-led Advance Care Planning (ACP) Intervention in Residential Care Homes

Официальное название

Implementing a Nurse-led Advance Care Planning (ACP) Intervention to Improve ACP Uptake in Residential Care Homes: An Implementation Science and Mixed Methods Pragmatic Cluster Randomized Controlled Trial

Обзор

The goal of this cluster randomized controlled trial is to examine the effectiveness of a nurse-led advance care planning (ACP) intervention on improving ACP discussion uptake in residential care homes (RCHs). The main question it aims to answer is: The effectiveness of nurse-led advance care planning (ACP) interventions implemented on eligible residents in residential care homes on improving ACP discussion uptake in this population. Compared to participants in the control group who will only receive usual care with no ACP intervention, residents and their family members in the intervention group will be invited to attend the ICP meeting with ACP discussion. The ACP discussion will be guided by the established protocol, which was developed by the expert panel and delivered by trained nurses.

Подробное описание

Targeted issue: The lack of ACP discussion and poor dyadic congruence pose challenges to the provision of good EOL care in Hong Kong RCHs.

Population: RCHs in Hong Kong with nurse-to-resident ratios ≥1:3 will be targeted to ensure adequate staffing to carry out ACP. Eligible participants have to be age 65 or older and be able to communicate in Cantonese or Mandarin. Participants will also be invited to identify family members involved in making decisions about their care to participate in the intervention.

Intervention: a nurse-led advance care planning (ACP) intervention

Main study aim: To implement a nurse-led ACP intervention for improving ACP uptake in RCH residents in Hong Kong to bridge the evidence-practice gap.

Study method: This implementation science study will use a mixed methods approach, including a pair-matched cluster-RCT and qualitative interviews, and relevant outcomes will be followed for up to 2 years. RCHs will be randomized into two groups: a nurse-led ACP intervention group and a control group with usual care only.The ACP documentation (i.e., new documentation related to ACP and EOL care) in medical records of all RCH residents in the intervention and control groups will be audited by the research team at baseline (T0), post-intervention (T1; after the ACP intervention), 1-year follow-up (T2; 1 year after the launch of the ACP intervention at the RCH), and 2-year follow-up (T3; 2 years after the launch of the ACP intervention at the RCH).

Вмешательства

• Поведенческое Nurse-led Advance Care Planning (ACP) Intervention
  An ACP discussion between the participating resident, family members, and the trained nurse will be incorporated into the annual review. The proposed ACP intervention will be divided into three parts (three weekly sessions, 1.5 hours each): 1) preparatory, 2) discussion, and 3) follow-up sessions.

Первичные конечные точки

• Change from Baseline in Chart review at post-intervention [Срок оценки: baseline and immediately after the intervention]
• Change from Baseline in Chart review at 1-year follow-up time point. [Срок оценки: 1-year follow-up (i.e., 1 year after the launch of the ACP intervention)]
• Change from Baseline in Chart review at 2-year follow-up time point. [Срок оценки: 2-year follow-up (i.e., 2 years after the launch of the ACP intervention at the RCH).]

Критерии участия

Критерии включения

• Eligible participants have to be age 65 or older and be able to communicate in Cantonese or Mandarin.
• Participants will also be invited to identify family members involved in making decisions about their care to participate in the intervention. For residents who have moderate or severe cognitive impairment (as determined by a score of less than 19 in the Hong Kong version of the Montreal Cognitive Assessment), the participation of family members is mandatory.

Критерии исключения

• They have a moderate or severe significant cognitive impairment but do not have family members, or
• They have prior ACP experience (e.g., AD completed).

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Да

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Поддерживающая терапия

Центры проведения

Гонконг · 1 центр

• The University of Hong Kong — Гонконг

Публикации

• Wang T, Cheung DST, Chu C, Chen J, Lin CC. Evaluation of a train-the-trainer implementation strategy on providers' competency, opportunity and motivation for advance care planning in residential care homes: a mixed-methods study. BMC Geriatr. 2026 Jan 3;26(1):155. doi: 10.1186/s12877-025-06898-2. PMID 41484702

Идентификаторы

NCT: NCT06238063 · UW 22-021

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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