Increasing engagement in advance care planning using a behaviour change model: study protocol for the STAMP...

Area of Science:

• Gerontology
• Health Services Research
• Behavioral Medicine

Background:

• Advance care planning (ACP) is crucial for high-quality end-of-life care but is underutilized.
• Behavior change interventions offer a flexible approach to increase engagement in ACP.
• The Sharing and Talking about My Preferences study addresses this gap through rigorous trials.

Purpose of the Study:

• To evaluate the efficacy of three distinct behavior change strategies in promoting ACP.
• To compare these interventions across two different healthcare settings: a Veterans Affairs (VA) medical center and community practices.
• To ultimately increase the completion of key ACP behaviors.

Main Methods:

• Two randomized controlled trials involving participants aged 55 and older.
• Community trial: Practice-level randomization to computer-tailored intervention (CTI) or usual care.
• VA trial: Participant-level randomization to CTI, motivational interviewing, motivational enhancement therapy, or usual care.

Main Results:

• Primary outcome: completion of four key ACP behaviors (surrogate decision-maker, goal communication, advance directives, medical record documentation).
• Analysis will employ mixed effects models, accounting for clustered randomization in the community setting.
• Study results will be disseminated to academic and healthcare leadership.

Conclusions:

• Behavior change interventions show promise for increasing ACP engagement.
• Findings will inform the development of effective ACP programs in diverse settings.
• This research contributes to improving end-of-life care planning and patient autonomy.