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Study protocol to investigate the efficacy of normalisation of Advance Care Planning (ACP) for people with chronic diseases in acute and community settings: a quasi-experimental design.
BMC Health Serv Res. 2019 May 04; 19(1):286.BH

Abstract

BACKGROUND

Advanced care planning (ACP) is a process that involves thinking about what medical care one would like should individuals be seriously ill and cannot communicate decisions about treatment for themselves. The literature indicates that ACP leads to increased satisfaction from both patients and healthcare professionals. Despite the well-known benefits of ACP, it is still underutilised in Australia.

METHODS

The aim of this study is to investigate the effects of normalising ACP in acute and community settings with the use of specially trained normalisation agents. This is a quasi-experimental study, involving 16 sites (8 intervention and 8 control) in two health districts in Australia. A minimum of total 288 participants will be recruited (144 intervention, 144 control). We will train four registered nurses as normalisation agents in the intervention sites, who will promote and facilitate ACP discussions with adult patients with chronic conditions in hospital and community settings. An audit of the prevalence of ACP and Advanced Care Directives (ACDs) will be conducted before and after the 6-month intervention period at the 16 sites to assess the effects of the ACP service delivered by these agents. We will also collect interview and survey data from patients and families who participate, and healthcare professionals who are involved in this service to capture their experiences with ACP.

DISCUSSION

This study will potentially contribute to better patient outcomes with their health care services. Completion of ACDs will allow patients to express their wishes for care and receive the care that they wish for, as well as ease their family from the burden of making difficult decisions. The study will contribute to development of a new best practice model to normalise ACP that is sustainable and transferable in the processes of: 1) initiation of conversation; 2) discussion of important issues; 3) documentation of the wishes; 4) storage of the documented wishes; and 5) access and execution of the documented wishes. The study will generate new evidence on the challenges, strategies and benefits of normalising ACP into practice in acute and community settings.

TRIAL REGISTRATION

This project has been approved by the Hunter New England Human Research Ethics Committee (Approval No. 17/12/13/4.16). It has also been retrospectively registered on 3 October 2018 with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246). This study will operate in accordance with the National Health and Medical Research Council's National Statement on Ethical Conduct in Human Research (2007) and the CPMP/ICH Note for Guidance on Good Clinical Practice.

Authors+Show Affiliations

School of Nursing and Midwifery, University of Newcastle, PO Box 127, Ourimbah, NSW, 2258, Australia. Sarah.Jeong@newcastle.edu.au.Department of Aged Care Services, Wyong Hospital, PO Box 4200, Lakehaven, NSW, 2263, Australia.Hunter New England Nursing and Midwifery Research Centre, James Fletcher Campus, Gate Cottage, 72 Watt St, Newcastle, NSW, 2300, Australia.Division of Aged, Subacute and Complex Care, PO Box 6088, Long Jetty, NSW, 2261, Australia.School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, 2308, Australia.Cumbria Partnership National Health Service Foundation Trust. E27 Ruskin Corridor, The Carleton Clinic, Cumwhinton Drive, Carlisle, CA1 3SX, UK.School of Nursing and Midwifery, University of Newcastle, PO Box 127, Ourimbah, NSW, 2258, Australia.Calvary Mater Hospital & Newcastle Private Hospital ICU, Organ and Tissue donation for the Hunter New England Local Health District , New Lambton Heights, Australia.

Pub Type(s)

Clinical Trial Protocol
Journal Article

Language

eng

PubMed ID

31054578

Citation

Jeong, Sarah, et al. "Study Protocol to Investigate the Efficacy of Normalisation of Advance Care Planning (ACP) for People With Chronic Diseases in Acute and Community Settings: a Quasi-experimental Design." BMC Health Services Research, vol. 19, no. 1, 2019, p. 286.
Jeong S, Barrett T, Ohr SO, et al. Study protocol to investigate the efficacy of normalisation of Advance Care Planning (ACP) for people with chronic diseases in acute and community settings: a quasi-experimental design. BMC Health Serv Res. 2019;19(1):286.
Jeong, S., Barrett, T., Ohr, S. O., Cleasby, P., David, M., Chan, S., Fairlamb, H., Davey, R., & Saul, P. (2019). Study protocol to investigate the efficacy of normalisation of Advance Care Planning (ACP) for people with chronic diseases in acute and community settings: a quasi-experimental design. BMC Health Services Research, 19(1), 286. https://doi.org/10.1186/s12913-019-4118-x
Jeong S, et al. Study Protocol to Investigate the Efficacy of Normalisation of Advance Care Planning (ACP) for People With Chronic Diseases in Acute and Community Settings: a Quasi-experimental Design. BMC Health Serv Res. 2019 May 4;19(1):286. PubMed PMID: 31054578.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Study protocol to investigate the efficacy of normalisation of Advance Care Planning (ACP) for people with chronic diseases in acute and community settings: a quasi-experimental design. AU - Jeong,Sarah, AU - Barrett,Tomiko, AU - Ohr,Se Ok, AU - Cleasby,Peter, AU - David,Michael, AU - Chan,Sally, AU - Fairlamb,Helen, AU - Davey,Ryan, AU - Saul,Peter, Y1 - 2019/05/04/ PY - 2019/02/21/received PY - 2019/04/22/accepted PY - 2019/5/6/entrez PY - 2019/5/6/pubmed PY - 2019/6/18/medline KW - Advanced care planning KW - Chronic disease KW - Clinical trial KW - Community KW - Hospital KW - Normalisation KW - Nursing KW - Protocol SP - 286 EP - 286 JF - BMC health services research JO - BMC Health Serv Res VL - 19 IS - 1 N2 - BACKGROUND: Advanced care planning (ACP) is a process that involves thinking about what medical care one would like should individuals be seriously ill and cannot communicate decisions about treatment for themselves. The literature indicates that ACP leads to increased satisfaction from both patients and healthcare professionals. Despite the well-known benefits of ACP, it is still underutilised in Australia. METHODS: The aim of this study is to investigate the effects of normalising ACP in acute and community settings with the use of specially trained normalisation agents. This is a quasi-experimental study, involving 16 sites (8 intervention and 8 control) in two health districts in Australia. A minimum of total 288 participants will be recruited (144 intervention, 144 control). We will train four registered nurses as normalisation agents in the intervention sites, who will promote and facilitate ACP discussions with adult patients with chronic conditions in hospital and community settings. An audit of the prevalence of ACP and Advanced Care Directives (ACDs) will be conducted before and after the 6-month intervention period at the 16 sites to assess the effects of the ACP service delivered by these agents. We will also collect interview and survey data from patients and families who participate, and healthcare professionals who are involved in this service to capture their experiences with ACP. DISCUSSION: This study will potentially contribute to better patient outcomes with their health care services. Completion of ACDs will allow patients to express their wishes for care and receive the care that they wish for, as well as ease their family from the burden of making difficult decisions. The study will contribute to development of a new best practice model to normalise ACP that is sustainable and transferable in the processes of: 1) initiation of conversation; 2) discussion of important issues; 3) documentation of the wishes; 4) storage of the documented wishes; and 5) access and execution of the documented wishes. The study will generate new evidence on the challenges, strategies and benefits of normalising ACP into practice in acute and community settings. TRIAL REGISTRATION: This project has been approved by the Hunter New England Human Research Ethics Committee (Approval No. 17/12/13/4.16). It has also been retrospectively registered on 3 October 2018 with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246). This study will operate in accordance with the National Health and Medical Research Council's National Statement on Ethical Conduct in Human Research (2007) and the CPMP/ICH Note for Guidance on Good Clinical Practice. SN - 1472-6963 UR - https://www.unboundmedicine.com/medline/citation/31054578/Study_protocol_to_investigate_the_efficacy_of_normalisation_of_Advance_Care_Planning__ACP__for_people_with_chronic_diseases_in_acute_and_community_settings:_a_quasi_experimental_design_ L2 - https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4118-x DB - PRIME DP - Unbound Medicine ER -