Evaluation of a train-the-trainer implementation strategy on providers' competency, opportunity and motivation for advance care planning in residential care homes: a mixed-methods study.

backgroundEngaging staff in residential care homes in advance care planning (ACP) is an increasingly important area. The train-the-trainer strategy driven by the Capacity Opportunity Motivation-Behavior Change Model is a promising approach but has limited data. The study aims to evaluate a theory-driven train-the-trainer implementation strategy on ACP engagement.

methodsAn explanatory sequential mixed-methods study was conducted to evaluate an implementation strategy, the train-the-trainer ACP program consisting of an ACP workshop and individualized field coaching. Surveys of ACP competency and ACP readiness were measured pre- and post-workshop. Interviews were conducted after individualized field coaching.

resultsSixteen enrolled nurses, 17 registered nurses, 18 health assistants, and 8 social workers (N = 59) were recruited from 10 care homes. The age of the care home residents ranged from 67 to 108 years old. Upon completion of the ACP workshop, participants had significant increases in their ACP competency scores from 80.44 ± 15.12 to 96.12 ± 10.79 (t = 5.953, p < 0.001), but no change in their readiness for engaging in ACP (Z = - 0.988, p = 0.329). Following individualized field coaching, participants further reported professional growth (communication skills, understanding of relevant practice guidelines, integration of ACP as a clinical communication tool, and additional role as an information provider and coordinator) and personal gains (appreciation of the health-illness trajectory, urgency to reflect on end-of-life planning, and being prepared to address the challenges of an aging population). Mixed methods analysis showed a distinct causal pathway revealing that participants' capacity was mostly impacted by the ACP workshop, while their opportunity and motivation in ACP were impacted by the field coaching.

conclusionThe ACP training program has successfully engaged staff in care homes by increasing their capacity, opportunity, and motivation.

trial registrationThe protocol (version 1.0, dated 20211201) of the trial was first registered on March 23rd, 2023, at ClinicalTrials.gov (identifier NCT06238063).