Background Advance care planning (ACP) is a multi-stage process which involves discussions between patients, family members, and health care providers, about their preferences of future treatment when they have become incompetent. Previous studies have showed benefits from different types of ACP which took place in diverse healthcare settings and patient populations.

Aim The purpose of this study is to develop a culturally oriented ACP intervention model for community older adults and examine its effectiveness.

Methods This will be an experimental research design study. Two district health centres in Taipei will be assigned to intervention and control groups. Based on the Transtheoretical Model, we will develop a 4-week theory-based ACP intervention model for community older adults in the intervention group. The control group will receive an ACP educational handbook. Both the intervention and control groups will complete three questionnaires (knowledge, attitudes, and stage of change regarding ACP) at baseline and again at a 4-week follow up.

Results The “ACP intervention model” guidelines and learning manuals will be developed and the effectiveness will be tested.

Discussion The ACP change process of the participants during the intervention will be observed, recorded and discussed. The feasibility of the ACP intervention model will also be discussed for community elderly.

Conclusion Develop general guidelines and ACP educational materials are needed in order to promote the autonomy of older adults and to enhance their quality of life.