Here is the standardised PICO analysis for the fifth uploaded article:
Full Title
Mixed methods process evaluation of an advance care planning intervention among nursing home staff
Authors: Joni Gilissen, Annelien Wendrich-Van Dael, Chris Gastmans, Luc Deliens, Robert Vander Stichele, Lara Pivodic, Lieve Van Den Block
Journal: Palliative Medicine, 2025; 39(1): 113–125
DOI: 10.1177/02692163241286652
Type of Study
Mixed-methods process evaluation embedded in a cluster randomised controlled trial (7 intervention homes in Belgium)
PICO Summary
Population (P)
- Staff in seven nursing homes in Flanders, Belgium
- Included management, nurses, care assistants, allied health professionals, and non-clinical staff (e.g., cleaners, admin)
- Secondary focus on nursing home residents and family members as beneficiaries of staff-delivered ACP
Intervention (I)
- ACP+ intervention
- An 8-month, multi-component, theory-informed program designed to integrate advance care planning into daily nursing home practice
- Involved:
- Role-based training (Reference Persons, Facilitators, Antennas)
- Monthly multidisciplinary meetings
- Audit and feedback
- Practical coordination
- Shadowing, coaching, and follow-up from external trainers
- Tailored organisational protocols and policy creation
Comparison (C)
- Not directly evaluated in this article (as this is a process evaluation of the intervention arm only). However, the overarching cluster RCT included a control group receiving usual care (not reported here).
Outcomes (O)
Person-centred outcomes:
- Not directly measured in this process evaluation (focus was on staff implementation and organisational outcomes)
Process outcomes:
- Dose, reach, fidelity, adaptations of intervention delivery
- Staff training attendance: only 33% of eligible staff attended (range 6%–69%)
- Implementation adaptations: 5 of 7 homes adapted activities; e.g., added coordinators, shortened sessions
- Organisational policy creation: all homes developed an internal ACP protocol
Health system/organisational outcomes:
- Increased awareness and systematisation of ACP across staff roles
- Perceived cultural shift toward integrating ACP into everyday care
- Barriers: time constraints, high turnover, staff absences, lack of GP involvement
Findings Summary
- While the ACP+ intervention was well received, staff engagement was limited due to systemic barriers
- Mechanisms for positive change included management support, clear staff roles, and accessible training
- Organisational culture was key to success; some trial effects (e.g., increased ACP conversations) were not captured by quantitative outcomes alone
- This evaluation underscores the importance of contextual, cultural, and team-based factors in the successful implementation of ACP in care homes
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