NCT03521206: ACP+

Advance Care Planning in Nursing Homes in Flanders

Completed NA Last updated 24 September 2019

What this trial tests

NA trial testing ACP+ programme in Advance Care Planning in 684 participants. Completed in 20 May 2019.

Timeline

1 March 2018

Primary endpoint
28 February 2019

20 May 2019

Quick facts

Lead sponsor	End-of-Life Research Group
Phase	NA
Status	Completed
Study type	INTERVENTIONAL
Allocation	randomized
Design	parallel
Masking	single
Primary purpose	health services research
Enrollment	684
Start date	1 March 2018
Primary completion	28 February 2019
Estimated completion	20 May 2019
Sites	1 location across Belgium

Drugs / interventions tested

• ACP+ programme

Conditions studied

• Advance Care Planning — all drugs for Advance Care Planning →
• Elderly Care — all drugs for Elderly Care →
• Nursing Home — all drugs for Nursing Home →

Sponsor

End-of-Life Research Group

Who can join

18 and older, any sex, with Advance Care Planning or Elderly Care. Patients with the condition only — healthy volunteers not accepted.

Sponsor's own description

Advance care planning (ACP) is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future (medical) care. ACP is of particular relevance for frail older adults, particularly in the nursing home setting where an important proportion of older people die. However, the actual implementation of ACP in nursing home practice seems to be a challenge in many countries worldwide, and people often do not get the opportunity to discuss their preferences in advance. This study evaluates the effectiveness of a theory-based advance care planning training programme (ACP+ programme) for nursing homes in Flanders, Belgium, using a cluster randomised controlled trial (cRCT) design. The ACP+ programme aims to integrate ACP in routine nursing home care by training the nursing home staff and management. Residents and their family will receive in-depth information on ACP and participate in one or several ACP conversations, if they wish so.

Who can participate? Nursing homes that conform to the eligibility criteria: at least 100 beds, situated in Flanders and did not participate in a similar research or implementation project over the last 4 years.

What does the study involve? The researchers will perform a cluster randomized controlled trial (cRCT) to evaluate the effects of an ACP training programme in nursing homes in Flanders (Belgium), accompanied by a process evaluation. Fourteen nursing homes will be randomized to either the intervention group, which will receive the intervention (ACP+ programme), or the control group, in which no additional training regarding ACP (other than that which is part of routine practice) will be provided. The nursing homes in the control group will receive a short training on ACP, as well as all training materials used in the intervention after the last follow-up measurements.

At month 0 the researchers will perform a baseline measurement in the intervention and control groups using structured questionnaires to be filled in by all care staff in the nursing home. At the end of month 8, the same questionnaires will be administered again in all nursing homes (follow-up). The process evaluation will employ structured diaries for ACP trainers, attendance lists for training sessions, audiotaping of a sample of ACP conversations and individual and group interviews with staff and management of the intervention homes.

Hypotheses The primary hypothesis is that the introduction of the ACP+ programme in nursing homes will improve the knowledge and self-efficacy of nursing home care staff regarding advance care planning.

Publications & conference data

6 peer-reviewed publications reference this trial (live from Europe PMC):

1. Nurses' self-efficacy, rather than their knowledge, is associated with their engagement in advance care planning in nursing homes: A survey study.
   Gilissen J, Pivodic L, Wendrich-van Dael A, Cools W, et al · · 2020 · cited 29× · PMID 32383636 · DOI 10.1177/0269216320916158
2. Implementing advance care planning in routine nursing home care: The development of the theory-based ACP+ program.
   Gilissen J, Pivodic L, Wendrich-van Dael A, Gastmans C, et al · · 2019 · cited 20× · PMID 31622389 · DOI 10.1371/journal.pone.0223586
3. Implementing the theory-based advance care planning ACP+ programme for nursing homes: study protocol for a cluster randomised controlled trial and process evaluation.
   Gilissen J, Pivodic L, Wendrich-van Dael A, Gastmans C, et al · · 2020 · cited 14× · PMID 31915000 · DOI 10.1186/s12904-019-0505-7
4. Effects of a theory-based advance care planning intervention for nursing homes: A cluster randomized controlled trial.
   Pivodic L, Wendrich-van Dael A, Gilissen J, De Buyser S, et al · · 2022 · cited 9× · PMID 35769038 · DOI 10.1177/02692163221102000
5. Differences in advance care planning among nursing home care staff.
   Gilissen J, Wendrich-van Dael A, Gastmans C, Vander Stichele R, et al · · 2021 · cited 7× · PMID 33947293 · DOI 10.1177/0969733021994187
6. Mixed methods process evaluation of an advance care planning intervention among nursing home staff.
   Gilissen J, Wendrich-Van Dael A, Gastmans C, Deliens L, et al · · 2025 · cited 2× · PMID 39410736 · DOI 10.1177/02692163241286652