Study on advance care planning in care dependent community-dwelling older persons in Germany (STADPLAN): protocol of a cluster-randomised controlled trial

Schnakenberg, Rieke; Silies, Katharina; Berg, Almuth; Kirchner, Änne; Langner, Henriette; Chuvayaran, Yuliya; Köberlein-Neu, Juliane; Haastert, Burkhard; Wiese, Birgitt; Meyer, Gabriele; Köpke, Sascha; Hoffmann, Falk

doi:10.1186/s12877-020-01537-4

Cited by 11 publications

(20 citation statements)

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“…The STADPLAN study (Study on advance care planning in care dependent community dwelling older persons) evaluated a complex intervention designed to target this opportunity. It is the first study to provide evidence on the effectiveness of an ACP programme provided by trained nurse facilitators in the home care setting [ 8 ]. The intervention’s core components were a training for nurses of home care services (nurse facilitators, NF), a minimum of two ACP conversations based on topic guides with their clients (patients) and an information brochure and workbook on ACP.…”

Section: Introductionmentioning

confidence: 99%

“…Family or surrogates were encouraged to participate in the intervention if patients gave their consent (Table 1 , intervention components). The intervention was evaluated in a cluster-randomised controlled trial in 27 German home care services in total, located at three study sites in the northern, western, and eastern part of Germany [ 8 ]. The primary outcome was patient activation, measured by the PAM-13 [ 9 , 10 ], assessing the degree to which individuals take an active role in managing their own health and healthcare and how competent they feel to fulfil that role.…”

Section: Introductionmentioning

confidence: 99%

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Contextual factors influencing advance care planning in home care: process evaluation of the cluster-randomised controlled trial STADPLAN

et al. 2022

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Background The STADPLAN study is a cluster-randomised controlled trial including 27 home care services in Germany. It assesses the effect of an advance care planning (ACP) intervention delivered by trained nurses to older care-dependent patients. Patients received two ACP conversations and an information brochure. Nurses were educated through a two-day programme and topic guides structuring the conversations. Objectives of the process evaluation were to determine: [1] whether the intervention was implemented as planned, [2] which change mechanisms were observed, [3] whether targeted process outcomes were achieved and [4] in which way contextual factors influenced the implementation process. Methods The process evaluation is based on a mixed methods approach following the recommendations of the UK-MRC framework for the development and evaluation of complex interventions. Qualitative and quantitative assessments were developed and analysed guided by a logic model comprising intervention, participants, mechanisms of change and context factors. The results of the main trial will be published elsewhere. Results Educational programme and topic guides were mostly implemented as planned and resulted in motivation, knowledge, and perceived competencies to facilitate ACP conversations in nurses. Deviances in the performance of ACP conversations indicated patients’ varied individual needs, but also obstacles like reluctance of patients and caregivers to participate actively and time constraints of nurse facilitators. Patients and caregivers reported increased awareness of ACP, planning and other activities indicating that targeted process outcomes could be achieved. The relevance of multifaceted contextual factors acting as barriers or facilitators for the engagement in ACP interventions on the individual, organisational and macro level was evident. Conclusions The process evaluation elicits obstacles and achievements of the ACP intervention. The logic model organised a plethora of mixed methods data into a holistic picture of multifaceted results. Nurses as ACP facilitators in home care can fulfil a crucial initiating role based on a trusting relationship with their patients. To support older care-dependent people’s ACP engagement, access should be simplified. Furthermore, education for nurse facilitators and sufficient resources for service provision are needed. Independent of monetary reimbursement, healthcare providers must respect patients’ choice for or against any ACP intervention. Ethics and trial registration Approved by the Ethics Committees of Martin Luther University Halle-Wittenberg (Ref.-No. 2019–045), Carl von Ossietzky University Oldenburg (Ref.-No. 2019–024), and University of Lübeck (Ref.-No. 19–080). German Clinical Trials Register: DRKS00016886. Registered retrospectively 04/06/2019, first participant included 29/05/2019.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Contextual factors influencing advance care planning in home care: process evaluation of the cluster-randomised controlled trial STADPLAN

et al. 2022

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“…The study protocol of the cluster-randomized trial has been published [11]. This paper outlines the comprehensive process evaluation conducted alongside the trial.…”

Section: The Stadplan Studymentioning

confidence: 99%

“…Despite such legislation, ACP and advance directives (AD) have not been sufficiently implemented [ 10 ]. Therefore, we will conduct a cluster-randomized controlled trial assessing a complex intervention aiming to promote ACP in community-dwelling older persons (the STADPLAN study: STudy on ADvance care PLANning in care-dependent community dwelling older persons) [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Process evaluation of a complex intervention to promote advance care planning in community-dwelling older persons (the STADPLAN study)—study protocol

Silies

Schnakenberg

Berg

et al. 2020

Trials

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Background: Process evaluation addresses the implementation, mechanisms of impact, and context of participants in complex interventions. The STADPLAN study assesses the effects of conversations on advance care planning (ACP) led by trained nurse facilitators. The complex intervention consists of several components that may lead to various changes in attitude and behavior regarding personal ACP activities. With the process evaluation, we aim to assess how changes were achieved in the STADPLAN intervention. Methods: The planned process evaluation study will be conducted alongside a cluster-randomized controlled trial on ACP in home care services (HCS). Trained nurse facilitators will deliver the ACP intervention consisting of an information brochure and two ACP conversations. A logic model depicts the assumed change processes of the intervention: the educational program enables nurses to conduct ACP conversations with patients and their caregivers. Patients gain knowledge and reflect upon and engage in their own ACP. Caregivers better understand patients' wishes and feel reassured in their role as surrogates. Designation of a surrogate and communication on ACP are facilitated. We will assess the effects of the educational program with questionnaires and a focus group including all participating nurses. We will measure ACP engagement, and prevalence of advance directives in patients, and ask for their experiences with the intervention. We will conduct semi-structured interviews with caregivers about their expectations and experiences regarding ACP in general and the intervention. We will address context factors, e.g., basic characteristics of the HCS (such as ownership, number of clients, staff and qualification). Analysis will be based upon the logic model, integrating qualitative and quantitative data.

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“…The US government promoted ADs to encourage members of the public to be proactive about expressing their end-of-life treatment wishes and a statutory basis was established in all 50 states, under the Patient Self-Determination Act (PSDA) in 1991 [ 2 ]. Although there are variations in the terms, for example, ADs in US [ 2 ] and Germany [ 3 ], and Advance Care Directives (ACDs) or Advance Health Directives in Australia [ 4 ], the need for and importance of end-of-life care decisions have ever since grown and have been contributed by a variety of factors. Among these are the ageing population [ 5 – 7 ], new life-sustaining technologies [ 8 ], rapidly increasing health-care costs [ 9 ], increasing patient awareness and demands for autonomy [ 10 , 11 ], and the increasing numbers of people with chronic diseases in hospital and the wider community [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

A cost-consequence analysis of normalised advance care planning practices among people with chronic diseases in hospital and community settings

Jeong

Ohr

Cleasby

et al. 2021

BMC Health Serv Res

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Background A growing body of international literature concurs that comprehensive and complex Advance Care Planning (ACP) programs involving specially qualified or trained healthcare professionals are effective in increasing documentation of Advance Care Directives (ACDs), improving compliance with patients’ wishes and satisfaction with care, and quality of care for patients and their families. Economic analyses of ACDs and ACP have been more sporadic and inconclusive. This study aimed to contribute to the evidence on resource use associated with implementation of ACP and to inform key decision-makers of the resource implications through the conduct of a cost-consequence analysis of the Normalised Advance Care Planning (NACP) trial. Methods The outcomes for the economic evaluation included the number of completed “legally binding” ACDs and the number of completed Conversation Cards (CC). The cost analysis assessed the incremental difference in resource utilisation between Usual Practice and the Intervention. Costs have been categorised into: 1) Contract staff costs; 2) Costs associated with the development of the intervention; 3) Implementation costs; 4) Intervention (delivery) costs; and 5) Research costs. Results The cost incurred for each completed ACD was A$13,980 in the hospital setting and A$1248 in the community setting. The cost incurred for each completed Conversation Card was A$7528 in the hospital setting and A$910 in the community setting. Conclusions The cost-consequence analysis does not support generalisation of the specified intervention within the hospital setting. The trial realised an estimated incremental cost per completed ACD of $1248, within the community setting. This estimate provides an additional benchmark against which decision-makers can assess the value of either 1) this approach towards the realisation of additional completed ACDs; and/or 2) the value of ACP and ACDs more broadly, when this estimate is positioned within the potential health outcomes and downstream health service implications that may arise for people with or without a completed ACD. Trial registration The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246). The URL of the trial registry record.

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Study on advance care planning in care dependent community-dwelling older persons in Germany (STADPLAN): protocol of a cluster-randomised controlled trial

Cited by 11 publications

References 49 publications

Contextual factors influencing advance care planning in home care: process evaluation of the cluster-randomised controlled trial STADPLAN

Contextual factors influencing advance care planning in home care: process evaluation of the cluster-randomised controlled trial STADPLAN

Process evaluation of a complex intervention to promote advance care planning in community-dwelling older persons (the STADPLAN study)—study protocol

A cost-consequence analysis of normalised advance care planning practices among people with chronic diseases in hospital and community settings

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