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

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 infor...

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Autores principales: Silies, Katharina, Huckle, Tilman, Schnakenberg, Rieke, Kirchner, Änne, Berg, Almuth, Köberlein-Neu, Juliane, Meyer, Gabriele, Hoffmann, Falk, Köpke, Sascha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020149/
https://www.ncbi.nlm.nih.gov/pubmed/35443623
http://dx.doi.org/10.1186/s12877-022-03026-2
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author Silies, Katharina
Huckle, Tilman
Schnakenberg, Rieke
Kirchner, Änne
Berg, Almuth
Köberlein-Neu, Juliane
Meyer, Gabriele
Hoffmann, Falk
Köpke, Sascha
author_facet Silies, Katharina
Huckle, Tilman
Schnakenberg, Rieke
Kirchner, Änne
Berg, Almuth
Köberlein-Neu, Juliane
Meyer, Gabriele
Hoffmann, Falk
Köpke, Sascha
author_sort Silies, Katharina
collection PubMed
description 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-03026-2.
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spelling pubmed-90201492022-04-20 Contextual factors influencing advance care planning in home care: process evaluation of the cluster-randomised controlled trial STADPLAN Silies, Katharina Huckle, Tilman Schnakenberg, Rieke Kirchner, Änne Berg, Almuth Köberlein-Neu, Juliane Meyer, Gabriele Hoffmann, Falk Köpke, Sascha BMC Geriatr Research 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-03026-2. BioMed Central 2022-04-20 /pmc/articles/PMC9020149/ /pubmed/35443623 http://dx.doi.org/10.1186/s12877-022-03026-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Silies, Katharina
Huckle, Tilman
Schnakenberg, Rieke
Kirchner, Änne
Berg, Almuth
Köberlein-Neu, Juliane
Meyer, Gabriele
Hoffmann, Falk
Köpke, Sascha
Contextual factors influencing advance care planning in home care: process evaluation of the cluster-randomised controlled trial STADPLAN
title Contextual factors influencing advance care planning in home care: process evaluation of the cluster-randomised controlled trial STADPLAN
title_full Contextual factors influencing advance care planning in home care: process evaluation of the cluster-randomised controlled trial STADPLAN
title_fullStr Contextual factors influencing advance care planning in home care: process evaluation of the cluster-randomised controlled trial STADPLAN
title_full_unstemmed Contextual factors influencing advance care planning in home care: process evaluation of the cluster-randomised controlled trial STADPLAN
title_short Contextual factors influencing advance care planning in home care: process evaluation of the cluster-randomised controlled trial STADPLAN
title_sort contextual factors influencing advance care planning in home care: process evaluation of the cluster-randomised controlled trial stadplan
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020149/
https://www.ncbi.nlm.nih.gov/pubmed/35443623
http://dx.doi.org/10.1186/s12877-022-03026-2
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