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Implementing advance care planning in routine nursing home care : the development of the theory-based ACP+ program

(2019) PLOS ONE. 14(10).
Author
Organization
Abstract
Background While various initiatives have been taken to improve advance care planning in nursing homes, it is difficult to find enough details about interventions to allow comparison, replication and translation into practice. Objectives We report on the development and description of the ACP+ program, a multi-component theory-based program that aims to implement advance care planning into routine nursing home care. We aimed to 1) specify how intervention components can be delivered; 2) evaluate the feasibility and acceptability of the program; 3) describe the final program in a standardized manner. Design To develop and model the intervention, we applied multiple study methods including a literature review, expert discussions and individual and group interviews with nursing home staff and management. We recruited participants through convenience sampling. Setting and participants Management and staff (n = 17) from five nursing homes in Flanders (Belgium), a multidisciplinary expert group and a palliative care nurse-trainer. Methods The work was carried out by means of 1) operationalization of key intervention components identified as part of a previously developed theory on how advance care planning is expected to lead to its desired outcomes in nursing homes into specific activities and materials, through expert discussions and review of existing advance care planning programs; 2) evaluation of feasibility and acceptability of the program through interviews with nursing home management and staff and expert revisions; and 3) standardized description of the final program according to the TIDieR checklist. During step 2, we used thematic analysis. Results The original program with nine key components was expanded to include ten intervention components, 22 activities and 17 materials to support delivery into routine nursing home care. The final ACP+ program includes ongoing training and coaching, management engagement, different roles and responsibilities in organizing advance care planning, conversations, documentation and information transfer, integration of advance care planning into multidisciplinary meetings, auditing, and tailoring to the specific setting. These components are to be implemented stepwise throughout an intervention period. The program involves the entire nursing home workforce. The support of an external trainer decreases as nursing home staff become more autonomous in organizing advance care planning. Conclusions The multicomponent ACP+ program involves residents, family, and the different groups of people working in the nursing home. It is deemed feasible and acceptable by nursing home staff and management. The findings presented in this paper, alongside results of the subsequent randomized controlled cluster trial, can facilitate comparison, replicability and translation of the intervention into practice.
Keywords
OF-LIFE OUTCOMES, RESIDENTS, INTERVENTIONS, FEASIBILITY, DEFINITION, DEMENTIA, PILOT

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MLA
Gilissen, Joni, et al. “Implementing Advance Care Planning in Routine Nursing Home Care : The Development of the Theory-Based ACP+ Program.” PLOS ONE, vol. 14, no. 10, 2019, doi:10.1371/journal.pone.0223586.
APA
Gilissen, J., Pivodic, L., Van Dael, A., Gastmans, C., Vander Stichele, R., Van Humbeeck, L., … Van den Block, L. (2019). Implementing advance care planning in routine nursing home care : the development of the theory-based ACP+ program. PLOS ONE, 14(10). https://doi.org/10.1371/journal.pone.0223586
Chicago author-date
Gilissen, Joni, Lara Pivodic, Annelien Van Dael, Chris Gastmans, Robert Vander Stichele, Liesbeth Van Humbeeck, Luc Deliens, and Lieve Van den Block. 2019. “Implementing Advance Care Planning in Routine Nursing Home Care : The Development of the Theory-Based ACP+ Program.” PLOS ONE 14 (10). https://doi.org/10.1371/journal.pone.0223586.
Chicago author-date (all authors)
Gilissen, Joni, Lara Pivodic, Annelien Van Dael, Chris Gastmans, Robert Vander Stichele, Liesbeth Van Humbeeck, Luc Deliens, and Lieve Van den Block. 2019. “Implementing Advance Care Planning in Routine Nursing Home Care : The Development of the Theory-Based ACP+ Program.” PLOS ONE 14 (10). doi:10.1371/journal.pone.0223586.
Vancouver
1.
Gilissen J, Pivodic L, Van Dael A, Gastmans C, Vander Stichele R, Van Humbeeck L, et al. Implementing advance care planning in routine nursing home care : the development of the theory-based ACP+ program. PLOS ONE. 2019;14(10).
IEEE
[1]
J. Gilissen et al., “Implementing advance care planning in routine nursing home care : the development of the theory-based ACP+ program,” PLOS ONE, vol. 14, no. 10, 2019.
@article{8632537,
  abstract     = {{Background
While various initiatives have been taken to improve advance care planning in nursing homes, it is difficult to find enough details about interventions to allow comparison, replication and translation into practice.
Objectives
We report on the development and description of the ACP+ program, a multi-component theory-based program that aims to implement advance care planning into routine nursing home care. We aimed to 1) specify how intervention components can be delivered; 2) evaluate the feasibility and acceptability of the program; 3) describe the final program in a standardized manner.
Design
To develop and model the intervention, we applied multiple study methods including a literature review, expert discussions and individual and group interviews with nursing home staff and management. We recruited participants through convenience sampling.
Setting and participants
Management and staff (n = 17) from five nursing homes in Flanders (Belgium), a multidisciplinary expert group and a palliative care nurse-trainer.
Methods
The work was carried out by means of 1) operationalization of key intervention components identified as part of a previously developed theory on how advance care planning is expected to lead to its desired outcomes in nursing homes into specific activities and materials, through expert discussions and review of existing advance care planning programs; 2) evaluation of feasibility and acceptability of the program through interviews with nursing home management and staff and expert revisions; and 3) standardized description of the final program according to the TIDieR checklist. During step 2, we used thematic analysis.
Results
The original program with nine key components was expanded to include ten intervention components, 22 activities and 17 materials to support delivery into routine nursing home care. The final ACP+ program includes ongoing training and coaching, management engagement, different roles and responsibilities in organizing advance care planning, conversations, documentation and information transfer, integration of advance care planning into multidisciplinary meetings, auditing, and tailoring to the specific setting. These components are to be implemented stepwise throughout an intervention period. The program involves the entire nursing home workforce. The support of an external trainer decreases as nursing home staff become more autonomous in organizing advance care planning.
Conclusions
The multicomponent ACP+ program involves residents, family, and the different groups of people working in the nursing home. It is deemed feasible and acceptable by nursing home staff and management. The findings presented in this paper, alongside results of the subsequent randomized controlled cluster trial, can facilitate comparison, replicability and translation of the intervention into practice.}},
  articleno    = {{e0223586}},
  author       = {{Gilissen, Joni and Pivodic, Lara and Van Dael, Annelien and Gastmans, Chris and Vander Stichele, Robert and Van Humbeeck, Liesbeth and Deliens, Luc and Van den Block, Lieve}},
  issn         = {{1932-6203}},
  journal      = {{PLOS ONE}},
  keywords     = {{OF-LIFE OUTCOMES,RESIDENTS,INTERVENTIONS,FEASIBILITY,DEFINITION,DEMENTIA,PILOT}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{20}},
  title        = {{Implementing advance care planning in routine nursing home care : the development of the theory-based ACP+ program}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0223586}},
  volume       = {{14}},
  year         = {{2019}},
}

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