Use of multimedia shared decision-making aids (EATING program) for improving advance care planning engagement among...

Discussing advance care planning (ACP) preferences for nasogastric tube (NG) insertion remains challenging among older adults. Multimedia decision-making aids have demonstrated potential to enhance understanding and support informed decision-making.

To evaluate the effectiveness of the EATING program (multimedia decision-making aids + traditional educational module) compared to usual care (traditional educational module alone) in improving ACP readiness on NG insertion for community older adults with chronic illness.

A single blind, two-arm parallel cluster randomized controlled trial was conducted across four community villages in Northern Taiwan. Participants from two villages received the EATING program, while the other two villages received the usual care. Eligible criteria included community older adults aged ≥65 with at least one chronic disease who were able to provide informed consent. Exclusion criteria included hearing or visual impairments or a history of mental illness. Pre- and post-intervention outcomes, along with one-month follow-up data, were analyzed using descriptive statistics and generalized estimating equations.

Both groups showed significant immediate improvements in knowledge (p < 0.001), belief/behavior (p < 0.001), decision confidence (p < 0.001), and readiness for ACP (p < 0.001). The experimental group showed greater improvement, particularly in emotional response and preferences (Z = -5.51, p < 0.001), observed only in this group. Sustained effect on knowledge (B = 35.029, p < 0.001), emotional response and preferences (B = 9.342, p < 0.001), refusal NG tube insertion (Z = -2.770, p = 0.006), and likelihood of signing official documents (p = 0.035) were observed after one month.

The study highlights the potential of multimedia program to enhance NG insertion discussions among community older adults. Further qualitative investigations and cultural adaptation are recommended.