Abstract
Background
The Enhanced Advance care planning and life Review Longitudinal Intervention (EARLI) Project is a cluster randomised controlled trial of proactive screening, reminiscence-based life story work and facilitated advance care planning (ACP), among older adults receiving home care services in Australia.
Methods
The life story work process involves facilitated reflection upon meaningful memories and co-production of a life story project to promote values clarification, communication with carers and meaning-based coping. The life story work and ACP discussions occur across four home visits, with the final session involving consultation with the participant’s general practitioner. The EARLI trial tests the effect of the four-session program, against an active control condition providing ‘usual care’ ACP (single home visit session focused on ACP discussion and education). Primary outcome measures include ACP engagement and ACP documentation in home care provider client records, both of which are hypothesised to increase at post-trial follow-up. Secondary outcomes include preferences regarding care and treatment scenarios, dyadic congruence in preferences, decisional conflict, anxiety, depression, meaning-based coping and relationship quality.
Results
A cross-sectional pilot survey of planned outcome measures was collected from 432 participants during 2022. Between October 2022 and February 2025 12 home care organisations participated in the EARLI trial, referring 284 clients, of whom 96 care recipients have been recruited along with 16 care partners. Data from recruited trial participants indicates a culturally diverse sample with moderate levels of baseline ACP engagement (M= 12.8, SD= 4.55 on the 4-item ACP engagement scale [range 5–20]) and low rates of formal ACP documentation (11/96, 11.5%).
Discussion
Primary and secondary outcomes will be reported, along with findings from a concurrent process evaluation. ANZCTR Trial Registration ID: ACTRN12622001399785.
Unique Contribution
This is the first randomised controlled trial of a combined life story work and advance care planning (ACP) program. Engagement with culture-specific aged care providers has enabled a culturally diverse study sample, reflecting four language groups (English, Italian, Mandarin, Cantonese). Detailed longitudinal follow up (baseline, 4-week, 8-week and 12-week) among participants in both groups provides rare information on the process of ACP engagement and preference stability in the short- to mid-term period.
Implications for Policy and Practice
There are well-known challenges associated with initiating advance care planning (ACP) in acute situations or during admission to residential aged care. This study demonstrates the feasibility of using entry into formalised home care services as a trigger for a comprehensive, holistic and person-centred approach to ACP.
