Discussion
RECRUITMENT, STILL
For our cluster-randomised controlled trial, we were only able to recruit about 40% of the planned sample size, limiting the study’s statistical power, although the planned number of home care services was almost reached. The ACP intervention provided by nurses of home care services did neither significantly affect patient activation nor quality of life after 12 months. In both groups the proportion with appointments of surrogates increased with no significant differences between groups.A Dutch study recently published by Overbeek et al. also used the PAM-13 as primary endpoint and did not find significant effects of a nurse-led ACP intervention in nursing home and home care settings after 12 months.In our study, on the other hand, the completion of appointments of surrogates increased in both groups during follow-up. Other studies lack information on this at baseline.Our study highlights important issues on conducting research in patients cared for by home care services. On the one hand, it is feasible to conduct randomised trials in home care services and none of those dropped out during our study. Still, recruitment was difficult. We invited a total of 346 home care services of whom eventually 27 took part. The main reasons for non-participation were time-constraints and lack of qualified personnel.