Advanced Care Planning for the Severely Ill Home-dwelling Elderly
Implementing Advanced Care Planning in the Routine Care for Acutely Admitted Patients in Geriatric Units: a Cluster Randomised Controlled Trial
University of Oslo
2,000 participants
Oct 18, 2023
INTERVENTIONAL
Conditions
Summary
This study will develop and evaluate a complex intervention to implement advance care planning for severely ill home-dwelling elderly acutely admitted to hospital, by using a cluster randomized design. Twelve Norwegian acute geriatric hospital units will participate in the main study, each as one cluster. Of the twelve clusters, half will receive implementation support and training immediately, and the other half will receive similar support after the intervention period. The study includes 1) assessment of implementation outcomes (fidelity) in the participating units,2) health service and clinical outcomes including a) questionnaires to all staff in the units before and after the implementation period, questionnaires to attending clinicians and qualitative interviews with health personnel and local unit leaders b) questionnaires to patients and their relatives, patients records and data from central health registers and qualitative interviews with patients and relatives. Furthermore we will assess barriers and facilitators for advance care planning in 1) a wider health service context, and 2) at the national, regional and municipal level, and do economic analyses.
Eligibility
Inclusion Criteria11
- Home-dwelling
- years or older
- Acutely admitted to the participating unit
- Sufficient language proficiency in Norwegian to answer the questionnaire
- Clinical frailty score of 4 or more
- The physician responsible for the patient's medical care answers "no" to "Surprise question" from Gold Standards Framework proactive identification guidance
- Both patient and a close relative (preferably the closest relative) would participate in ACP together if offered
- Both patient and the close relative consent to participate in the research project
- years or older
- Sufficient language proficiency in Norwegian to answer the questionnaire
- Both patient and the close relative consent to participate in the research project
Exclusion Criteria14
- The patient is not competent to consent to research participation
- The patient is expected to die within 24 hours
- The patient has participated in ACP prior to the current hospital admission
- In the intervention arm
- ACP is not conducted with patient, next of kin and physician before hospital discharge
- The clinician that participated in the ACP conversation has not consented to research participation
- In the control arm
- The patient would not have been able to participate in ACP during hospitalization
- An attending clinician has not consented to research participation
- The relative is not competent to consent to research participation
- In the intervention arm
- ACP is not carried out with the patient, next of kin and attending clinician before hospital discharge
- In the control arm
- The relative would not have been able to participate in ACP during hospitalization
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Interventions
The intervention consists of: I Implementation strategies: 1.1 Ensuring leadership commitment 1.2 Responsive evaluation 1.3 Whole ward approach 1.4 Train the trainer model 1.5 Sustainability after the study II Implementation interventions 2.1 Implementation team 2.2 ACP coordinator 2.3 Training and supervision: Kick-off, training of resource persons and health care personnel including practical exercises, network conferences 2.4 Toolkit and shared resources: ACP guideline, teaching material, information leaflets, documentation templates etc. 2.5 Structured fidelity measurements of the implementation level of a) the implementation interventions and b) the clinical intervention, with tailored feedback and supervision III Clinical intervention: Advance Care Planning 3.1 Routine information and invitation to Advance Care Planning to all eligible patients 3.2 Written information to patients and relatives 3.3 Documentation and collaboration with other health care levels
Locations(12)
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NCT05681585