Please select the eligibility criteria that correspond to the clinical trial below.
Title: Advance Care Planning in Nursing Homes in Flanders, a Cluster Randomized Controlled Trial and Process Evaluation
Brief Summary: Advance care planning (ACP) is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future (medical) care. ACP is of particular relevance for frail older adults, particularly in the nursing home setting where an important proportion of older people die. However, the actual implementation of ACP in nursing home practice seems to be a challenge in many countries worldwide, and people often do not get the opportunity to discuss their preferences in advance. This study evaluates the effectiveness of a theory-based advance care planning training programme (ACP+ programme) for nursing homes in Flanders, Belgium, using a cluster randomised controlled trial (cRCT) design. The ACP+ programme aims to integrate ACP in routine nursing home care by training the nursing home staff and management. Residents and their family will receive in-depth information on ACP and participate in one or several ACP conversations, if they wish so.

Who can participate? Nursing homes that conform to the eligibility criteria: at least 100 beds, situated in Flanders and did not participate in a similar research or implementation project over the last 4 years.

What does the study involve? The researchers will perform a cluster randomized controlled trial (cRCT) to evaluate the effects of an ACP training programme in nursing homes in Flanders (Belgium), accompanied by a process evaluation. Fourteen nursing homes will be randomized to either the intervention group, which will receive the intervention (ACP+ programme), or the control group, in which no additional training regarding ACP (other than that which is part of routine practice) will be provided. The nursing homes in the control group will receive a short training on ACP, as well as all training materials used in the intervention after the last follow-up measurements.

At month 0 the researchers will perform a baseline measurement in the intervention and control groups using structured questionnaires to be filled in by all care staff in the nursing home. At the end of month 8, the same questionnaires will be administered again in all nursing homes (follow-up). The process evaluation will employ structured diaries for ACP trainers, attendance lists for training sessions, audiotaping of a sample of ACP conversations and individual and group interviews with staff and management of the intervention homes.

Hypotheses The primary hypothesis is that the introduction of the ACP+ programme in nursing homes will improve the knowledge and self-efficacy of nursing home care staff regarding advance care planning.


Options:
A: Inclusion Criteria:

* Eligible residents will be long-term care residents at least 65 years of age who have resided in the NH at least 6 months and are likely to survive at least 6 months. Residents must be potentially at risk for falls, which we define as ambulatory or transfer-independent as recorded on the Minimum Data Set.

Exclusion Criteria:

* None.
B: Inclusion Criteria:

* patient aged 65 or more, with a dementia diagnosed by a specialist or the general practitioner;
* patient presenting with a disruptive NPS as defined in French Haute Autorité de Santé (HAS) recommendations (2009), that requires a specialist consultation based on the LTCF staff judgment;
* informed and written consent by the patient or the legal representative or the reliable person when appropriate;
* general practitioner agreement.

Exclusion Criteria:

* patient's life expectancy less than 6 months;
* Non agreement of study participation of patients or legal representative or the reliable person when appropriate.
C: Inclusion Criteria:

* Inclusion criteria for nursing homes:

  1. the board of directors/the management express explicit motivation to participate in the study and agree to allocate at least a 0,10 FTE per week for at least two ACP Reference Person(s) per 30 to 40 nursing home beds, to carry out the tasks that are part of this project
  2. have at least 100 beds

Inclusion criteria for care staff in the nursing homes:

1. able to speak and understand Dutch.
2. work in a participating nursing home as either (head) nurse, care assistant, psychologist, physiotherapist, occupational therapist, social worker, animator, or reference person dementia/palliative care

Exclusion Criteria:

* Exclusion criteria for nursing homes:

  1. nursing homes have taken/are taking part in another research study that is evaluating palliative care services or communication strategies, currently or in the past 4 years
  2. they have - or are planning to develop during the foreseen duration of the trial - an extensive ACP policy, meaning that (i) all nursing home residents or their family (in principal) regularly receive ACP conversations (two conversations or more each year) or (ii) the nursing home is judged by the researchers as having explicit and detailed ACP guidelines available (corresponding to high-quality ACP procedures and practices)
  3. major organisational changes or physical changes to the facility (e.g. building activities or staff re-organisation) are planned or ongoing during the study period.
D: Inclusion Criteria:

* LTC facility must be located within the Toronto Central or Central LHIN geographic boundaries.
* LTC facility must be \<100 km from the St. Michael's Hospital wound care team.
* LTC facility must be entering data into MDS.
* LTC facility administrator must consent to participate.
* LTC facility must report a PU prevalence rate \>5.5% in the 4th quarter 2009 MDS. \[This is the average pressure ulcer prevalence rate for Ontario LTC facilities as reported by the Canadian Institute of Health Information (CIHI) in the 4th quarter 2009.\]
* Individual with PU (or Substitute Decision Maker (SDM)) must provide informed consent.

Exclusion Criteria:

* LTC facility \<100 beds.
* LTC facility \>100 km from the St. Michael's Hospital wound care team
* LTC facility reporting a PU prevalence rate \< 5.5% in the 4th quarter 2009 MDS.

Answer: C