Nursing Research Unit, University of Lübeck, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562, Lübeck, Germany.
Department for Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 140, 26129, Oldenburg, Germany.
BMC Geriatr. 2022 Apr 20;22(1):345. doi: 10.1186/s12877-022-03026-2.
The STADPLAN study is a cluster-randomised controlled trial including 27 home care services in Germany. It assesses the effect of an advance care planning (ACP) intervention delivered by trained nurses to older care-dependent patients. Patients received two ACP conversations and an information brochure. Nurses were educated through a two-day programme and topic guides structuring the conversations. Objectives of the process evaluation were to determine: [1] whether the intervention was implemented as planned, [2] which change mechanisms were observed, [3] whether targeted process outcomes were achieved and [4] in which way contextual factors influenced the implementation process.
The process evaluation is based on a mixed methods approach following the recommendations of the UK-MRC framework for the development and evaluation of complex interventions. Qualitative and quantitative assessments were developed and analysed guided by a logic model comprising intervention, participants, mechanisms of change and context factors. The results of the main trial will be published elsewhere.
Educational programme and topic guides were mostly implemented as planned and resulted in motivation, knowledge, and perceived competencies to facilitate ACP conversations in nurses. Deviances in the performance of ACP conversations indicated patients' varied individual needs, but also obstacles like reluctance of patients and caregivers to participate actively and time constraints of nurse facilitators. Patients and caregivers reported increased awareness of ACP, planning and other activities indicating that targeted process outcomes could be achieved. The relevance of multifaceted contextual factors acting as barriers or facilitators for the engagement in ACP interventions on the individual, organisational and macro level was evident.
The process evaluation elicits obstacles and achievements of the ACP intervention. The logic model organised a plethora of mixed methods data into a holistic picture of multifaceted results. Nurses as ACP facilitators in home care can fulfil a crucial initiating role based on a trusting relationship with their patients. To support older care-dependent people's ACP engagement, access should be simplified. Furthermore, education for nurse facilitators and sufficient resources for service provision are needed. Independent of monetary reimbursement, healthcare providers must respect patients' choice for or against any ACP intervention.
Approved by the Ethics Committees of Martin Luther University Halle-Wittenberg (Ref.-No. 2019-045), Carl von Ossietzky University Oldenburg (Ref.-No. 2019-024), and University of Lübeck (Ref.-No. 19-080).
DRKS00016886. Registered retrospectively 04/06/2019, first participant included 29/05/2019.
STADPLAN 研究是一项整群随机对照试验，纳入了德国的 27 家家庭护理服务机构。它评估了由经过培训的护士为老年依赖型患者提供的预先护理计划（ACP）干预的效果。患者接受了两次 ACP 对话和一份信息手册。护士通过为期两天的方案和对话指南接受教育。该过程评估的目的是确定：[1]干预措施是否按计划实施，[2]观察到哪些变化机制，[3]是否达到了预定的过程结果，以及 [4]以何种方式影响实施过程的环境因素。
该过程评估基于混合方法方法，遵循英国 MRC 框架用于开发和评估复杂干预措施的建议。根据包括干预措施、参与者、变化机制和环境因素在内的逻辑模型，制定并分析了定性和定量评估。主要试验的结果将在其他地方公布。
教育计划和主题指南大多按计划实施，并使护士在促进 ACP 对话方面产生了动力、知识和感知能力。ACP 对话表现的偏差表明患者的个体需求存在差异，但也存在一些障碍，例如患者和护理人员不愿积极参与以及护士促进者的时间限制。患者和护理人员报告说，他们对 ACP、计划和其他活动的认识有所提高，这表明可以实现预定的过程结果。多方面的环境因素对个人、组织和宏观层面的 ACP 干预的参与起到了障碍或促进作用，这一点显而易见。
该过程评估揭示了 ACP 干预措施的障碍和成就。逻辑模型将大量混合方法数据组织成一个多方面结果的整体图景。护士作为家庭护理中的 ACP 促进者，可以基于与患者的信任关系发挥至关重要的启动作用。为了支持老年依赖型人群的 ACP 参与，应简化访问途径。此外，还需要对护士促进者进行教育，并为服务提供充足的资源。医疗保健提供者必须尊重患者对任何 ACP 干预的选择或反对，而不仅仅是金钱上的补偿。
由马丁路德大学哈勒-维滕贝格伦理委员会（参考编号 2019-045）、奥尔登堡卡尔冯奥西茨基大学（参考编号 2019-024）和吕贝克大学（参考编号 19-080）批准。
DRKS00016886。于 2019 年 4 月 6 日进行回顾性注册，于 2019 年 5 月 29 日纳入第一位参与者。
