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BOS3c.004 Effectiveness of a complex advance care planning intervention focusing on nursing home residents: first results of the cluster-randomized controlled BEVOR-trial
  1. Kornelia Götze1,
  2. Berend Feddersen2,
  3. Eva Hummers3,
  4. Georg Marckmann4,
  5. Friedemann Nauck5,
  6. Jan Schildmann6,
  7. Antonia Zapf7 and
  8. Jürgen in der Schmitten8
  1. 1Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany, Duesseldorf, Germany
  2. 2Department of Palliative Medicine, Munich University Hospital, Germany, Munich, Germany
  3. 3Institute of General Practice, Medical Faculty, University of Göttingen, Germany, Göttingen, Germany
  4. 4Institute of Ethics, History and Theory of Medicine, Ludwig Maximilians University Munich, Germany, Munich, Germany
  5. 5Department of Palliative Medicine, University Medical Center Göttingen, Germany;, Göttingen, Germany
  6. 6Institute for History and Ethics of Medicine, Martin Luther University Halle-Wittenberg, Germany;, Halle, Germany
  7. 7Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany, Hamburg, Germany
  8. 8Institute of Family Medicine/General Practice, Medical Faculty, University of Duisburg-Essen, Germany, Essen, Germany


Background Few trials on advance care planning (ACP) have investigated the clinical effect on care consistency with care preferences (3CP) in the nursing home (NH) setting.

Methods BEVOR is a multi-centre, cluster-randomized controlled trial aimed to improve 3CP in NH residents (09/2019–02/2023). A total of 44 NHs from 4 German regions were randomized either to the control group (n=24) or the intervention group (n=24). The complex ACP intervention comprised the offer to lead ACP conversations with qualified facilitators on the individual (resident) level and offers for organizational development and staff education on the institutional (NH) level. Educational ACP modules were offered to emergency medical services, hospitals and other regional players relevant for these residents’ medical care.

After a run-in phase of the intervention, which was extended due to the Covid19-pandemic from originally 9 to (up to) 18 months, the observation period was 12 months from September 2021 to August 2022. Primary outcome was defined as hospitalization rate, understood as a surrogate parameter for 3CP, collected as anonymous data from all residents of the participating NHs. Main secondary outcome is 3CP, taken from a subset of 892 residents (20.5%) who gave informed consent. To measure 3CP, treatment decisions in potentially life-threatening events (‘care delivered’) were identified retrospectively every 3 months from the NH records. Correspondingly, ‘care preferences’ were assessed retrospectively, integrating data from residents’ files and interviews with residents, proxies and nurses, also taking into account the effected level of shared decision making. Analysis of the primary outcome follows the intention-to-treat principle.

Results The main outcomes will be available by the time of the acp-i conference.

Conclusion Results of the BEVOR trial will give insights into possible clinical effects of a complex regional ACP intervention.

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