Life In The Slower Lane

Here is the PICO analysis for the uploaded article:

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✅ PICO Analysis

Full Article Title:

Implementing the theory-based advance care planning ACP+ programme for nursing homes: study protocol for a cluster randomised controlled trial and process evaluation

Type of Study:

Study protocol for a cluster randomised controlled trial (RCT) with an embedded process evaluation

Journal and Year:

BMC Palliative Care (2020); Volume 19, Article 5

DOI: 10.1186/s12904-019-0505-7

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P – Population

• Setting: Nursing homes in Flanders, Belgium
• Inclusion criteria for sites: ≥100 beds, motivated leadership, staff availability to act as ACP Reference Persons
• Participants: Nursing home staff and volunteers
  • Care staff includes nurses, care assistants, psychologists, physiotherapists, occupational therapists, social workers, spiritual carers, etc.
  • Support staff includes cleaning, admin, technical/logistics, and kitchen staff with resident contact but no direct care roles
  • Volunteers must be ≥18 years and able to speak Dutch
• Note: Residents and families are not the direct intervention targets but are included in the process evaluation via interviews.

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I – Intervention

• Name: ACP+ programme (a multicomponent, theory-based intervention)
• Description:
  • Implemented over 8 months with external trainer support
  • Includes: staff training, coaching, role designation (ACP Reference Persons, Conversation Facilitators, Antennas), structured ACP conversations, information dissemination, documentation processes, and audits
  • Tailored to local context, with integration into routine care workflows
  • Training includes 22 activities and 17 materials (see Table 1 and 4 in the article)

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C – Comparison

• Comparison Group:
  • “Usual care” in matched control nursing homes
  • These facilities continue current practices, which may include some ACP training or activities, but no implementation of the ACP+ programme
  • No process evaluation is conducted in the control group

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O – Outcomes

Primary Outcomes (staff level):

1. Knowledge of advance care planning (ACP)
2. Self-efficacy (confidence in conducting ACP conversations)

Secondary Outcomes:

1. Attitudes towards ACP (care staff only)
2. ACP practices (care, support staff and volunteers)
3. Self-efficacy (support staff and volunteers)

Outcome Characteristics:

• Type: Process and person-centred outcomes (e.g. staff capability, behaviour change)
• Measurement Tools:
  • Structured self-report questionnaires adapted from existing tools (Detering et al., Ulster University)
  • Likert scales used to assess confidence, knowledge, and attitudes
  • ACP practices measured via yes/no questions about activities in the past 6 months

Note:

• Health system outcomes such as hospital admissions or care concordance are mentioned as potential future evaluation metrics but are not primary or secondary outcomes in this protocol.

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