Trial registration:
depression, anxiety, ’
German Clinical Trials Register: DRKS00016886
Advance care planning can help to inform health care providers and relatives about a person’s priorities, beliefs, values and choices and, therefore, expanding advance care planning to all older people has been demanded.Most studies on the effects of advance care planning in older people were conducted in institutional settings such as hospitals or nursing homes and only few studies from European countries are available.
Our cluster-randomised controlled trial conducted in 27 home care services with 380 patients showed no influence of a formal advance care planning counselling by nurse facilitators on patients’ active participation in their care after 12 months of follow-up, but our study is limited by a lack of statistical power.This complex advance care planning intervention also had no effect on quality of life, anxiety and depression, advance care planning engagement and the proportion of participants with advance directives.
The intervention primarily focusing on promoting patients’ awareness had no effect on any of our assessed endpoints. Therefore, different endpoints and possibly more tailored interventions should be used in future studies.In the light of the more recent literature, there seem to be growing evidence that advance care planning interventions do not alter patient-reported outcomes but seem to improve advance care planning discussion and documentation, which seems specifically important, when palliative care is provided.