The implementation and evaluation of an advance care planning education intervention in a long-term care facility: a feasibility study

In facing the rapidly ageing population, conversations relating to advance care planning (ACP) become increasingly important in supporting individuals and their families to make treatment decisions during the end-of-life phase. This study aimed to design, implement, and evaluate a transtheoretical model-based ACP education intervention for health and social care professionals (HSCPs) in a long-term care facility, assessing its impact on participants' knowledge, self-efficacy, and ACP practices. The study adopted a mixed-methods pre-post design, with quantitative surveys and qualitative focus-group interviews conducted at baseline and six months post-intervention. Twelve HSCPs were recruited, and the research was conducted from November 2022 to May 2023 in Macau. The intervention showed positive effects on knowledge improvement. Despite increased intention amongst HSCPs to practise ACP and an increased numbers of HSCPs initiating discussions with residents or their relatives, self-efficacy did not exhibit an overall improvement post-intervention. Both quantitative and qualitative results indicated lingering uncertainties regarding their role in executing ACP and the nomination of a single surrogate decision-maker for a resident. Results of the study showed that the ACP intervention, addressed multiple domains, including knowledge, self-efficacy, and maintenance efforts, was associated with improvements in ACP knowledge of HSCPs regarding ACP.