Taking action: the effect of a community action intervention on advance personal planning by older adults

Arm 1: Community Action Intervention (12 months duration). Individuals with legitimacy in each community, representing key stakeholder groups and consumer advisors will be identified by the research team. Individuals will be invited to be involved in the study as members of Coalition Groups. Coalition Groups will be established to support the implementation of the intervention strategies in each community. Membership will be dependent on local context. Standard resource packages will be developed by the research team to facilitate implementation of the intervention, including: an implementation manual; inter-professional and community information education materials (e.g. PowerPoints, checklists); print and audio-visual materials. Where possible, publically available materials (e.g. from organisations such as Advance Care Planning Australia) will be incorporated into the packages. Members of the Coalition Groups will meet as needed during the study via face-to-face and/or videoconference meetings. Comprehensive toolbox of intervention strategies. A comprehensive toolbox of strategies will be available for implementation and strategies will be selected for implementation at the discretion of the community Coalition Groups. The research team will provide advice and support to communities to identify and prioritise specific barriers and enablers to APP, and select and implement strategies to promote APP uptake. Strategy 1: Inter-professional education workshops to improve capacity assessment and promote APP. A list of potential workshop attendees in each community (e.g. lawyers, GPs, nurses, hospital staff) will be generated based on lists from relevant organisations (e.g. Primary Health Networks). Individuals will be mailed/emailed an invitation to attend the workshop (either face-to-face or via zoom). The 2-hour workshop will be directed by two facilitators trained by the research team (i.e. a lawyer & health professional from the community) and will involve a combination of didactic lectures, small group discussions and role plays. Topics will include: legal rights and responsibilities, capacity assessment, strategies and resources to facilitate APP. They will also be given access to a suite of resources, including: links to existing capacity assessment toolkits (e.g. NSW Government Planning Ahead, NSW Justice); downloadable APP fact sheets, proformas and guides available from Advance Care Planning Australia and the Law Society of NSW; and information about existing education and training resources materials they can access (e.g. https://end-of-life.qut.edu.au/; https://www.advancecareplanning.org.au/resources/education-and-training#/). Up to 3 sessions will be held in each community over a period of 12 months. The number of attendees will be recorded and attendees will complete a survey of knowledge, attitudes, and acceptability at session end. Strategy 2: Community APP sessions for older people. Eligible community organisations will be informed via email and letter about free 1.5 hour APP information session(s) (face-to-face or via zoom) and asked to invite members. Sessions will also be advertised via local media. Sessions will be facilitated by trained health and legal professionals, with information on the purpose and benefit of APP; legal rights and responsibilities; and techniques for facilitating discussions presented. Instructions for accessing existing resources and hard copies of documents will be provided. Attendees will complete a survey of knowledge, attitudes, and acceptability at session end. Instructions for accessing existing resources and hard copies of documents will be provided. These publically available documents will include: Advance Care Planning Australia Factsheets, NSW Enduring Guardian Booklet and Form and Advance Care Directive Booklet. Links to additional online resources and organisations where attendees can seek assistance or further information will also be provided, including: Advance Care Planning Australia, COTA NSW and Seniors Rights Service. Up to 3 sessions will be held in each community over a period of 12 months. The number of attendees will be recorded and attendees will complete a survey of knowledge, attitudes, and acceptability at session end. Strategy 3: Information for older people attending health and legal services regarding APP. General practices, ACCHSs and legal firms will be approached by the Coalition Group for consent to place print materials including posters and APP documents in waiting rooms. Information about the potential benefits of APP instruments, local services and additional resources available to assist people to engage in APP will be provided. Information about the potential benefits of APP instruments, local services and additional resources available to assist people to engage in APP will be provided. These publically available documents will include: Advance Care Planning Australia Factsheets, NSW Enduring Guardian Booklet and Form and Advance Care Directive Booklet. The number of materials distributed to each practice will be recorded. Strategy 4: Public awareness campaigns. The media component of this action approach will be the primary mechanism by which ongoing APP data obtained from lawyers will be fed back to the general community. The purpose is to generate a substantive increase in the number of APP-related news items. The benefits of APP and services available to assist in APP preparation will be communicated by: advertisements in local newspaper/radio every 4 months; media releases; short videos played as part of loop advertising at community organisations (e.g. bowling clubs, RSLs); written leaflets distributed via mail outs (e.g. with council rate notices); posters and handouts distributed in public libraries and/or pharmacies. These publically available documents have been obtained via organisations such as Advance Care Planning Australia (e.g. Factsheets) and NSW Health. This strategy will be implemented over a period of 12 months. The number of APP-related news items published will be recorded. Audit of APP performance with feedback APP over time. GPs and lawyers in each intervention community will be asked to collect de-identified data on the number of clients who request, complete or update APP instruments during the intervention period. Aggregate data only is needed. No individuals will be identified. Data will be collected every month to ensure accuracy. Follow up reminders will enhance adherence. Data will be mapped against previous data to monitor progress. This community-specific data will be presented to Coalition Group members to aid monitoring of strategies.