Maximizing Teachable Moments: Motivational Interviewing (MI) to Enhance Advance Care Planning (ACP) for Older Adults and Caregivers After Emergency Visits - A Mixed-Method Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 300
- 试验地点
- 1
- 主要终点
- Older adults' readiness for ACP
研究概览
简要总结
This study aims to evaluate the effectiveness of a motivational interviewing (MI) intervention in enhancing advance care planning (ACP) among older adults who have visited the Emergency Room (ER) in the past six months and their family caregivers. The main question it aims to answer is: The effectiveness of the MI-based ACP intervention implemented within six months of an ER visit on improving older adults' advance directives (AD) completion rate.
Compared to participants in the control group who will only receive a self-education booklet, participants in the intervention group will receive a motivational interview educational intervention to see the effectiveness of an MI-based ACP intervention implemented within six months following an emergency room visit regarding the completion of AD for older adults.
详细描述
Targeted issue: At present no feasible method exists to empower older adults following ER visits to engage in ACP in Hong Kong.
Population: The target group will be dyads comprising older adults who have had ER visits within the previous six months and their family caregivers.
Intervention: An MI-based ACP intervention our team developed.
Main study aim: To investigate the effectiveness of an MI-based ACP intervention implemented within six months following an emergency room visit on completion of AD for older adults compared to a self-education group.
Study method: Investigators will recruit eligible participants from two largest public hospitals, including the geriatric outpatient clinic of Queen Mary Hospital (IRB Ref: UW23-402) and the accident & emergency department of Queen Elizabeth Hospital (IRB Ref: KC/KE-23-0058/ER-1). A parallel RCT (allocation ratio= 1:1) with a post-trial qualitative study will be adopted and three follow-up time points at 3-, 6- and 12-month post-intervention. Participants in the intervention group will receive a dyadic motivational interview educational intervention, while participants in the comparison group will receive the pictorial ACP educational booklet for self-learning only. Patients unable to nominate a family caregiver will receive the elderly alone motivational interview educational intervention. Completion of AD and health service utilization will be assessed at three follow-up time points. In addition, a post-intervention interview, regarding stakeholders' views on the relevance, effectiveness, and experience of the intervention., will be conducted.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Single (Outcomes Assessor)
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •The target group will be dyads comprising older adults who have had ER visits within the previous six months and their family caregivers. A dyad is defined as one older adult and one primary family caregiver of the older adult.
- •For older adults:
- •Inclusion Criteria:
- •Aged 65 or older
- •At least one episode of ER visit in the last six months
- •Has a family caregiver to be present during the intervention
- •Able to communicate in Chinese
排除标准
- •Has completion of an AD
- •Moderate to severe cognitive impairment or diagnosis of dementia, as identified in health records
- •Communication problems (e.g., deafness or aphasia)
- •For family caregivers:
- •Inclusion Criteria:
- •Aged 18 or above
- •Immediate or extended family member or friend nominated by an eligible older adult participant as primary caregiver
- •Able to communicate in Chinese
- •Exclusion Criteria:
- •Moderate to severe cognitive impairment
- •Communication problems (e.g., deafness or aphasia)
研究组 & 干预措施
Self-learning
Older adult-family member dyads in this arm will receive a self-learning ACP educational material developed by the Hong Kong Hospital Authority.
Dyadic motivational interviewing advance care planning (MI-ACP)
Older adult-family member dyads in this arm will receive an MI-based education intervention our team developed.
干预措施: Dyadic MI-ACP intervention (Behavioral)
Elderly alone MI-ACP
Older adults in this arm will receive an MI-based education intervention our team developed.
干预措施: Elderly alone MI-ACP (Behavioral)
结局指标
主要结局
Older adults' readiness for ACP
时间窗: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.
Older adults' readiness for ACP (primary outcome) will be measured by the readiness subscales of the Advance Care Planning Engagement Survey (ACPES), which comprises 6 items rated on a 5-point Likert scale, ranging from 1 (worst outcome) to 5 (best outcome). A higher score indicates a higher readiness for ACP. It assesses an individual's readiness to sign official papers for health decision delegates and ADs and readiness to talk with family and physicians about EOL care, and has been validated in Hong Kong.
次要结局
- Older adults and family caregivers' congruence in goal of EOL care(before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.)
- Family caregivers' readiness for ACP(before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.)
- Older adults' emotional perception of ACP(before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.)
- Older adults' and family caregivers' decisional conflict(before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.)
- Older adults' completion of AD documentation(before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months(T3) post intervention .)
- Older adults' health service utilization(3-month (T1), 6-month (T2), and 12-months (T3) post intervention.)
- Older adults' and family caregivers' baseline characteristics(before the intervention (T0))
- Older adults and family caregivers' experience with the Nurse Navigation Program(3-month (T1) post intervention)
研究者
Professor Chia-Chin Lin
Professor
The University of Hong Kong