Motivational Interviewing to Enhance Advance Care Planning for Older Adults and Caregivers After Emergency Visits

NCT06090240 | Recruiting

• 1 other identifier: IRB-2023-150, HKWC-2023-342
• Study Type: interventional
• Target: 376
• Locations: 1 country
• Sites: 1

Brief Summary

This study aims to evaluate the effectiveness of a motivational interviewing (MI) intervention in enhancing advance care planning (ACP) among older adults who have visited the Emergency Room (ER) in the past six months and their family caregivers. The main question it aims to answer is: The effectiveness of the MI-based ACP intervention implemented within six months of an ER visit on improving older adults' advance directives (AD) completion rate. Compared to participants in the control group who will only receive a self-education booklet, participants in the intervention group will receive a motivational interview educational intervention to see the effectiveness of an MI-based ACP intervention implemented within six months following an emergency room visit regarding the completion of AD for older adults.

Conditions

Older Adults; Advance Care Planning; Advance Directives; Family Members

Outcome Measures

Primary Outcomes (1)

• Older adults' readiness for ACP

  Older adults' readiness for ACP (primary outcome) will be measured by the readiness subscales of the Advance Care Planning Engagement Survey (ACPES), which comprises 6 items rated on a 5-point Likert scale, ranging from 1 (worst outcome) to 5 (best outcome). A higher score indicates a higher readiness for ACP. It assesses an individual's readiness to sign official papers for health decision delegates and ADs and readiness to talk with family and physicians about EOL care, and has been validated in Hong Kong.

  before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.

Secondary Outcomes (8)

• Family caregivers' readiness for ACP

  before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.

• Older adults' emotional perception of ACP

  before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.

• Older adults' and family caregivers' decisional conflict

  before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.

• Older adults and family caregivers' congruence in goal of EOL care

  before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.

• Older adults' completion of AD documentation

  before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months(T3) post intervention .

Study Arms (2)

Motivational Interview

EXPERIMENTAL

Older adult-family member dyads in this arm will receive an MI-based education intervention our team developed.

Other: MI-based ACP intervention

Self-learning

NO INTERVENTION

Older adult-family member dyads in this arm will receive a self-learning ACP educational material developed by the Hong Kong Hospital Authority.

Interventions

MI-based ACP intervention OTHER

Motivational Interviewing on Advance Care Planning Intervention: Dyads of older adults and family caregivers will receive three MI-based ACP counselling sessions: (1) a preparatory session, (2) motivation session, and (3) planning session. The preparatory session will take 10-15 minutes, and the following two sessions in weeks 2 and 3 will last 30-45 minutes each. Before each session, the nurse interventionist will first assess the dyad's readiness to engage in ACP based on the state of change algorithm. Participants who have never thought about ACP will be in the pre-contemplation state, those who are willing to discuss EOL care and preferences to be in the contemplation state, those ready to talk about EOL planning to be in the preparation state, and those in the action state have a confirmed action plan on signing up their ADs. Readiness-based ACP goals will be established, and state-matched MI counseling will be customized for each participant.

Motivational Interview

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Aged 65 or older
• At least one episode of ER visit in the last six months
• Has a family caregiver to be present during the intervention
• Able to communicate in Chinese

You may not qualify if:

• Has completion of an AD
• Moderate to severe cognitive impairment or diagnosis of dementia, as identified in health records
• Communication problems (e.g., deafness or aphasia)
• For family caregivers:
• Aged 18 or above
• Immediate or extended family member or friend nominated by an eligible older adult participant as primary caregiver
• Able to communicate in Chinese
• Moderate to severe cognitive impairment
• Communication problems (e.g., deafness or aphasia)

Sponsors & Collaborators

• The University of Hong Kong: lead

Study Sites (1)

University of Hong Kong, School of Nursing

Hong Kong, Hong Kong

RECRUITING

Study Officials

• Chia-Chin LIN, PhD,FAAN,RN

  University of Hong Kong, School of Nursing

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Chia-Chin LIN, PhD,FAAN,RN

CONTACT

852-3917-6600; cclin@hku.hk

Tongyao Wang, PhD

CONTACT

852-3917-2790; tongyao1@hku.hk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 13, 2023
• First Posted: October 19, 2023
• Study Start: October 20, 2023
• Primary Completion: July 31, 2025
• Study Completion: July 31, 2025
• Last Updated: June 29, 2025

Record last verified: 2025-06

Data Sharing

• IPD Sharing: Will not share

Locations

HK (1)