Intervention and control
The development of the complex intervention is described elsewhere.On the cluster level, nurse facilitators employed by the respective home care services received a 2-days training to be prepared for their role as facilitator. This workshop provided an introduction on and the possibilities of documenting ACP. Nurse facilitators were trained to lead conversations based on standardised topic guides developed in the STADPLAN study. Conversation experiences and problems, as well as coping strategies were discussed. To participate, nurse facilitators had to have a minimum qualification of 3-year vocational training.On the patient level, the intervention included a formal ACP counselling including two conversations (being at least 2 weeks apart) and a written information brochure, both provided by the nurse facilitators. The brochure supported the discussion of health care preferences and wishes regarding future treatment by reflective questions. It further included a glossary of medical and legal terms as well as contact information on local consultancies. In the first conversation (about 30 min), the brochure was delivered and explained. During the second conversation (about 60 min) nurse facilitators discussed questions regarding the brochure as well as attitudes, preferences and values of the patients regarding future medical treatment and care. Conversations followed semi-structured topic guides and took place at the patient’s home. The patient’s proxy decision-maker or another person of trust, if available, was also invited to take part.All intervention components were piloted in four home care services including conversations with 36 patients in order to test feasibility and acceptability.Patients in the control group received optimised usual care, that is, provision of a short information brochure on ACP. Apart from the interventions, intervention and control group clusters were treated equally.