Life In The Slower Lane

Here is the PICO analysis for the seventeenth uploaded article:

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✅ PICO Analysis

Full Article Title:

Study protocol for ‘we DECide’: implementation of advance care planning for nursing home residents with dementia

Type of Study:

Quasi-experimental pre-test–post-test intervention study (with control group)

Journal and Year:

Journal of Advanced Nursing (2015); 71(5):1156–1168

DOI: 10.1111/jan.12601

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P – Population

• Setting:
  • 19 nursing homes in Flanders, Belgium
• Participants:
  • Nursing home staff (both organisational and clinical levels)
  • Indirectly: residents with dementia and their family caregivers involved in advance care planning (ACP) discussions 

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I – Intervention

• Name: ‘we DECide’ – Discussing End-of-life Choices
• Structure:
  • Education and communication training based on Elwyn’s three-step shared decision-making (SDM) model:
    1. Choice Talk – introducing care options
    2. Option Talk – discussing risks and benefits
    3. Decision Talk – guiding residents/families to a decision
  • Delivered as:
    • Workshop 1 (Choice Talk) – theory + role-play at admission
    • Homework Assignment (Option Talk) – ACP in daily informal conversations
    • Workshop 2 (Decision Talk) – role-play in crisis situations
  • Training included tailored materials (e.g. SDM pocket cards, practice guidelines), small-group coaching, and reflection exercises 

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C – Comparison

• Control Group:
  • Matched nursing homes with similar baseline ACP audit scores
  • Received no intervention during the study period, but were offered the programme post-study
• Internal Comparison:
  • Pre- and post-intervention measurements at organisational and clinical levels within the intervention group 

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O – Outcomes

Organisational Level (assessed with ACP-Audit):

• 9 domains measured, including:
  • Conversations at admission, about preferences, with families, in crisis, and during palliative phase
  • Documentation practices, team meetings, and shared decisions
• Total score range: 0–45; higher scores reflect better organisational support for ACP 

Clinical Level:

1. OPTION Scale (observed shared decision-making):
   • Evaluation of recorded real-life ACP conversations (e.g., at admission or during crisis)
   • Observer-rated on 12 items (0–4 points each; total 0–48) 
2. IFC-SDM Questionnaire (Importance-Frequency-Competence):
   • 9 items based on the SDM model
   • Each item rated for:
     • Importance of the behaviour
     • Frequency of performing it
     • Competence in performing it
   • Higher discrepancy scores indicate unmet training needs 

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Outcome Classification

• Person-centred outcomes: Indirectly targeted by improving quality of ACP conversations and inclusion of resident/family preferences
• Process outcomes: Improvements in shared decision-making skills, frequency of ACP discussions, and organisational support for ACP
• Health system outcomes: Potential for reduced crisis-driven hospitalisations or unwanted interventions, though not directly measured in this protocol

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Summary Conclusion

The ‘we DECide’ intervention is a structured, evidence-based educational program aimed at equipping nursing home staff with communication skills to conduct shared decision-making in advance care planning for residents with dementia. It aligns ACP conversations to three critical timepoints: admission, crisis, and informal daily contexts. Using a quasi-experimental design across 19 Belgian nursing homes, the intervention was assessed at both organisational and clinical levels using validated and custom-developed tools. Anticipated outcomes include improved SDM competencies, increased frequency and quality of ACP conversations, and more person-centred end-of-life care planning .

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