ESR12

The effectiveness of advance care planning (ACP) as a complex health technology for people with dementia in nursing homes

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BelgiumVrije Universiteit Brussel (VUB) Belgium
Supervisor(s) Prof. Lieve Van den Block
Early Stage Researcher (ESR12) Annelien van Dael
Annelien van Dael
Hi, my name is Annelien van Dael. I studied Clincal and Health Psychology at Utrecht University (Utrecht, the Netherlands). After I finished my studies I started working at the Geriatrics department of the Radboudumc in Nijmegen.

First on a study researching the effects of oral administered THC on agitation and aggression in dementia patients. After that I was involved in a research project about transferring care for elderly cancer patients from the hospital to the General Practitioner.

I really enjoy working with elderly people and in organizing care for them I find it most important to have a holistic view. Currently I am working on the INDUCT-project about Advanced Care Planning (ESR 12) and living in Ghent with my husband and our two cats, Max and Moritz.

 

Start date September 2016
Duration 36 months

Objectives

ESR12 will be involved in enrolling an additional 4 nursing homes (2+2), perform outcome and process analyses to evaluate not only whether or not ACP has impact on people’s quality of life and quality of dying but also how the intervention is producing its effects. ESR12 will use the MRC guidance on process evaluation of complex interventions (Moore et al 2014) to examine implementation, mechanisms of impact and context. Quantitative and qualitative data are collected during implementation of the intervention (via structured diary of country trainers and nursing staff responsible for the intervention) and after as part of a post-evaluation scale up (via interviews and focus groups with staff and family of residents with dementia).This extends an ongoing study (2014-2018) in Belgium evaluating the effect of advance care planning in 8 nursing homes (4 intervention and 4 control) on residents’ and families’ quality of life, and their evaluation of the quality of care, using a cluster randomized controlled trial. Advance care planning is defined as the continuous, early-initiated process of communication and discussions between health care providers, patients and families about the goals and desired direction of future health care, in the event that the patient should become incompetent to make or participate in decisions. The intervention is a complex health technology including multiple components, tools and guidelines. The ongoing study is underpowered to study the effect for people with dementia and does not include in depth process evaluation.

Expected Results

ESR12 will be involved in data collection and analyses (quantitative and qualitative outcome and process evaluation) to investigate 1) the intervention improves residents with dementia’s quality of life, their families’ quality of life and burden, and quality of care and communication processes, as is hypothesized; and 2) how the ACP intervention is having its effect and how ACP can be implemented optimally in nursing homes. After translation of the material, the ESR will perform a qualitative process analyses focusing on people with dementia in particular. The results will demonstrate potential on the barriers and facilitators to implementation of advance care planning in nursing homes for people with dementia, and provide detailed guidance on best practice for effectively using the intervention.

Planned secondment(s)

Two secondments of 3 months. Firstly to UK-CZ to explore the context of long term care in a new setting and secondly to Hertfordshire University (CRIPACC) to study mixed methods for evaluating complex interventions.

Dissemination