Clinical trial NCT06090240: Motivational Interviewing to Enhance Advance Care Planning for Older Adults and Caregivers After Emergency Visits
Official title: 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
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Older Adults
Advance Care Planning
Advance Directives
Family Members
Lead sponsor: The University of Hong Kong
Sponsor class: OTHER
First posted: 2023-10-19
Enrollment: 376
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: 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.

Detailed description: 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 motivational interview educational intervention, while participants in the comparison group will receive the pictorial ACP educational booklet for self-learning only. 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.

Eligibility criteria: 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

Exclusion Criteria:

* 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)

Primary outcomes:
measure: Change from Baseline in Completion of AD documentation at 3 Months
timeFrame: 3 months
measure: Change from Baseline in Completion of AD documentation at 6 Months
timeFrame: 6 months
measure: Change from Baseline in Completion of AD documentation at 12 Months
timeFrame: 12 months
Secondary outcomes:
Other outcomes:
Locations:
city: Hong Kong
country: Hong Kong
facility: University of Hong Kong, School of Nursing
Study officials:
affiliation: University of Hong Kong, School of Nursing
name: Chia-Chin LIN, PhD,FAAN,RN
role: PRINCIPAL_INVESTIGATOR
References: