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Communication about the end of life in nursing homes: a cluster randomised controlled trail

Advance Care Planning (ACP) intervention for nursing homes in Flanders and evaluation of the effectiveness


08-2014 to 08-2018

Abstract project


Advance care planning (ACP) is a continuous, early-initiated process of communication between care providers, patients and families about the goals and desired direction of future health care, in the event that the patient should lose capacity. Contemporary ACP models are not only focused on preparing for incapacity, but also on empowering people to have a say about their treatment while they have capacity.

While ACP has been advocated widely across and outside Europe, particular for older nursing home residents, there is limited evidence about its effectiveness in terms of residents’ and family outcomes. In addition it remains unclear how to develop an intervention that is effective and subsequently to perform an evaluation that can unravel effective components, mechanisms of change through which this intervention leads to or fails in its desired effect, and to outline clearly the contextual factors critical for optimal implementation.


The objective is to develop and evaluate the effectiveness of an intervention in the nursing home setting (Flanders, Belgium) concerning advance care planning, and the underlying mechanisms of change in an outcome and process evaluation. The overarching research question is: What is an effective advance care planning model for the nursing home setting?


We will use the UK Medical Research Council’s (MRC) framework concerning complex interventions to develop and pilot the intervention, and combine this with the Theory of Change (ToC) methodology to develop the conceptual framework of the intervention. The effectiveness of ACP and its process is evaluated in a cluster randomized controlled trial guided by the ToC model.


This study will provide high-quality evidence regarding the effectiveness of, and the causal mechanisms associated with change in, an intervention concerning early communication about the end of life in nursing homes residents.
Please find below the links to the main output of the research project: PhD dissertation, Study protocol and Midterm report 2018-2019.


VZP+ tool (Dutch text only)

De VZP+ tools in deze Toolkit werden ontwikkeld door een multidisciplinair team van experten, op basis van academisch literatuuronderzoek, een contextanalyse, verschillende stakeholderpanels (verpleegkundigen, maatschappelijk assistenten, huisartsen, coördinerende en raadgevende artsen, directie en beleid). De bruikbaarheid werd afgetoetst bij management en zorgverleners van vijf WZC in Vlaanderen, en verpleegster met bijkomende expertise in palliatieve zorg. De tools werden geïmplementeerd gedurende negen maanden in 14 woonzorgcentra, in het kader van een gerandomiseerde studie.

Download de VZP+ Toolkit door op de knop te drukken:

VZP toolkit


The Research Foundation – Flanders (FWO)

Project group

Researcher: Joni Gilissen
Promotor: Lieve Van den Block
Co-promotor: Luc Deliens
Senior researcher: Lara Pivodic
Project group member: Robert Vander Stichele
Project group member: Chris Gastmans (KU Leuven)

Information in Dutch

Click here for more info