Enhanced Advance care planning and life Review Longitudinal Intervention (EARLI): Protocol for a cluster randomized controlled cross-over trial of life story work and facilitated advance care planning among older Australian adults in community settings

Ava Karusoo-Musumeci; Ling Yeoh; Rebecca Walton; Tiet-Hanh Dao-Tran; Elizabeth Halcomb; Kirsten A Auret; Josephine M Clayton; Susan Kurrle; Elissa Campbell; Michelle Hilgeman; Ron Sinclair; Anne Meller; Simon Towler; Caroline E Edwards; Tracy Comans; Craig Sinclair

doi:10.1016/j.cct.2024.107795

Enhanced Advance care planning and life Review Longitudinal Intervention (EARLI): Protocol for a cluster randomized controlled cross-over trial of life story work and facilitated advance care planning among older Australian adults in community settings

Contemp Clin Trials. 2024 Dec 30:107795. doi: 10.1016/j.cct.2024.107795. Online ahead of print.

Authors

Ava Karusoo-Musumeci¹, Ling Yeoh², Rebecca Walton³, Tiet-Hanh Dao-Tran⁴, Elizabeth Halcomb⁵, Kirsten A Auret⁶, Josephine M Clayton⁷, Susan Kurrle⁸, Elissa Campbell⁹, Michelle Hilgeman¹⁰, Ron Sinclair¹¹, Anne Meller¹², Simon Towler¹³, Caroline E Edwards², Tracy Comans¹⁴, Craig Sinclair¹⁵

Affiliations

¹ Neuroscience Research Australia (NeuRA), Sydney, Australia.
² Neuroscience Research Australia (NeuRA), Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia.
³ Brightwater Group, Perth, Australia.
⁴ Centre for Health Services Research, University of Queensland, Brisbane, Australia.
⁵ School of Nursing, University of Wollongong, Wollongong, Australia.
⁶ Rural Clinical School of Western Australia, University of Western Australia, Albany, Australia.
⁷ The Palliative Centre, HammondCare, Sydney, Australia; Northern Clinical School, University of Sydney, Sydney, Australia.
⁸ Northern Clinical School, University of Sydney, Sydney, Australia.
⁹ University of Western Australia, Perth, Australia.
¹⁰ Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA; Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA.
¹¹ University of Adelaide, Adelaide, Australia.
¹² Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, Australia.
¹³ Fiona Stanley Hospital, Perth, Australia.
¹⁴ Centre for Health Services Research, University of Queensland, Brisbane, Australia; National Ageing Research Institute, Melbourne, Australia.
¹⁵ Neuroscience Research Australia (NeuRA), Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia. Electronic address: [email protected].

PMID: 39743017
DOI: 10.1016/j.cct.2024.107795

Abstract

Background: Advance care planning (ACP) is potentially helpful for older adults, however, the rate of uptake in community aged care settings is low. Previous pilot studies suggest that holistic, person-centered ACP approaches may be effective for older adults who experience functional impairment but do not necessarily have life-limiting conditions with clear prognoses. This paper describes the protocol of a randomized trial to test the effectiveness of combined life story work and facilitated ACP in promoting ACP engagement among older adults receiving community aged care services.

Methods: The Enhanced Advance care planning and life Review Longitudinal Intervention (EARLI) trial is an open-label, cross-over, cluster randomized controlled trial with 12 participating aged care organizations in New South Wales and Western Australia. Participants are aged 65 years or older, receiving home care services and capable of providing informed consent at initial recruitment. Recruitment occurs across a two-year period, with study sites randomized to receive the four-session intervention in the first or second year (or a single session 'active control' condition). Primary outcomes are participant-reported ACP engagement and ACP documentation in the aged care client record 12 weeks post-recruitment. Secondary outcomes include measures of decisional conflict, anxiety and depression, meaning-based coping and relationship quality. Analysis will take an intention-to-treat approach.

Conclusion: This trial tests a novel method of reaching older adults using a holistic, person-centered approach to promoting ACP engagement. Enhancing ACP engagement may reduce decisional conflict, minimize hospital admissions and improve outcomes for people and their families. ANZCTR Trial Registration ID: ACTRN12622001399785.

Keywords: Advance care planning; Chronic disease; Decisional conflict; Home care; Life story work; Older adults.