Older AdultsNCT06090240
Motivational Interviewing to Enhance Advance Care Planning for Older Adults and Caregivers After Emergency Visits
A study testing Dyadic MI-ACP intervention and Elderly alone MI-ACP in people with Older Adults and Advance Care Planning, run by The University of Hong Kong at 1 site in Hong Kong.
Trial summary
This study aims to evaluate the effectiveness of a motivational interviewing (MI) intervention in enhancing advance care planning (ACP) among older adults who have visited the Emergency Room (ER) in the past six months and their family caregivers. Read more about this study
- Who is it for?
- Any ageHealthy volunteers can take part
- Conditions the study is for
- Older Adults, Advance Care Planning, Advance Directives
- What is being tested?
- Dyadic MI-ACP intervention and Elderly alone MI-ACP
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 300 participants
- Where
- 1 siteHong Kong
- Study dates
- 14 Dec 2023to 31 Jul 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Who may be able to join
- Aged 65 or older
- At least one episode of ER visit in the last six months
- Has a family caregiver to be present during the intervention
- Able to communicate in Chinese
- Aged 18 or above
- Immediate or extended family member or friend nominated by an eligible older adult participant as primary caregiver
- Able to communicate in Chinese
Who cannot join
- Has completion of an AD
- Moderate to severe cognitive impairment or diagnosis of dementia, as identified in health records
- Communication problems (e.g., deafness or aphasia)
- For family caregivers:
- Moderate to severe cognitive impairment
- Communication problems (e.g., deafness or aphasia)
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Hong Kong1 site, 1 recruiting
- Recruiting
University of Hong Kong, School of Nursing
Hong Kong
Jialing Chen, 39103442, jialing1@hku.hk
About this study
Official title: Maximizing Teachable Moments: Motivational Interviewing (MI) to Enhance Advance Care Planning (ACP) for Older Adults and Caregivers After Emergency Visits - A Mixed-Method Randomized Controlled Trial
This study aims to evaluate the effectiveness of a motivational interviewing (MI) intervention in enhancing advance care planning (ACP) among older adults who have visited the Emergency Room (ER) in the past six months and their family caregivers. The main question it aims to answer is: The effectiveness of the MI-based ACP intervention implemented within six months of an ER visit on improving older adults' advance directives (AD) completion rate.
Compared to participants in the control group who will only receive a self-education booklet, participants in the intervention group will receive a motivational interview educational intervention to see the effectiveness of an MI-based ACP intervention implemented within six months following an emergency room visit regarding the completion of AD for older adults.
Read the detailed description
Targeted issue: At present no feasible method exists to empower older adults following ER visits to engage in ACP in Hong Kong.
Population: The target group will be dyads comprising older adults who have had ER visits within the previous six months and their family caregivers.
Intervention: An MI-based ACP intervention our team developed.
Main study aim: To investigate the effectiveness of an MI-based ACP intervention implemented within six months following an emergency room visit on completion of AD for older adults compared to a self-education group.
Study method: Investigators will recruit eligible participants from two largest public hospitals, including the geriatric outpatient clinic of Queen Mary Hospital (IRB Ref: UW23-402) and the accident \& emergency department of Queen Elizabeth Hospital (IRB Ref: KC/KE-23-0058/ER-1). A parallel RCT (allocation ratio= 1:1) with a post-trial qualitative study will be adopted and three follow-up time points at 3-, 6- and 12-month post-intervention. Participants in the intervention group will receive a dyadic motivational interview educational intervention, while participants in the comparison group will receive the pictorial ACP educational booklet for self-learning only. Patients unable to nominate a family caregiver will receive the elderly alone motivational interview educational intervention. Completion of AD and health service utilization will be assessed at three follow-up time points. In addition, a post-intervention interview, regarding stakeholders' views on the relevance, effectiveness, and experience of the intervention., will be conducted.
- Being tested
- Dyadic MI-ACP intervention, Elderly alone MI-ACP
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Dyadic MI-ACP interventionBehavioural
Motivational Interviewing on Advance Care Planning Intervention: Dyads of older adults and family caregivers will receive three MI-based ACP counselling sessions: (1) a preparatory session, (2) motivation session, and (3) planning session. The preparatory session will take 10-15 minutes, and the following two sessions in weeks 2 and 3 will last 30-45 minutes each. Before each session, the nurse interventionist will first assess the dyad's readiness to engage in ACP based on the state of change algorithm. Participants who have never thought about ACP will be in the pre-contemplation state, those who are willing to discuss EOL care and preferences to be in the contemplation state, those ready to talk about EOL planning to be in the preparation state, and those in the action state have a confirmed action plan on signing up their ADs. Readiness-based ACP goals will be established, and state-matched MI counseling will be customized for each participant.
Elderly alone MI-ACPBehavioural
Older adults in this arm will receive an MI-based education intervention our team developed.
| Study group | Role | What they receive |
|---|---|---|
| Dyadic motivational interviewing advance care planning (MI-ACP) | Experimental | Older adult-family member dyads in this arm will receive an MI-based education intervention our team developed. Receives: Behavioral: Dyadic MI-ACP intervention |
| Self-learning | No intervention | Older adult-family member dyads in this arm will receive a self-learning ACP educational material developed by the Hong Kong Hospital Authority. |
| Elderly alone MI-ACP | Experimental | Older adults in this arm will receive an MI-based education intervention our team developed. Receives: Behavioral: Elderly alone MI-ACP |
What is being measured
The primary outcome is the main question the study is designed to answer.
Older adults' readiness for ACP
Older adults' readiness for ACP (primary outcome) will be measured by the readiness subscales of the Advance Care Planning Engagement Survey (ACPES), which comprises 6 items rated on a 5-point Likert scale, ranging from 1 (worst outcome) to 5 (best outcome). A higher score indicates a higher readiness for ACP. It assesses an individual's readiness to sign official papers for health decision delegates and ADs and readiness to talk with family and physicians about EOL care, and has been validated in Hong Kong.
Measured: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.
Secondary outcomes (8)
Family caregivers' readiness for ACP
Family caregivers' readiness for ACP will be measured by the researcher-developed family caregivers' ACP engagement survey (FACP-10), which consists of 10 items rated on a 5-point Likert scale, ranging from 1 (worst outcome) to 5 (best outcome). A Higher score indicates a higher readiness for ACP. The survey assesses family caregivers' self-reported levels of ACP knowledge, readiness to discuss ACP with a loved one, self-efficacy in initiating ACP conversations with a loved one and barriers to such initiation, and emotional perceptions of and attitudes toward ACP, as well as whether having the necessary communication tools for ACP conversations. We developed the instrument based on the key domains reported in ACPES and the constructs identified in a systematic review of family caregivers' roles in ACP. Our pilot data demonstrated adequate reliability of the scale in Hong Kong family caregivers.
Measured: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.
Older adults' emotional perception of ACP
Older adults' emotional perception of ACP will be measured by the 3 item self-efficacy subscale (SE-3) of the ACPES on a 5-point Likert scale, ranging from 1 (worst outcome) to 5 (best outcome), with higher scores indicating greater confidence about participating in ACP. The scale has been validated in Chinese.
Measured: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.
Older adults' and family caregivers' decisional conflict
Decisional conflict will be measured by both older adults' and family caregivers' responses to the Decisional Conflict Scale (DCS), which consists of 16 items in 5 domains (informed, values clarity, support, uncertainty, and effective decision) scored on a 5-point Likert scale, ranging from 1 (worst outcome) to 5 (best outcome). A Higher scores indicate more decisional conflict when considering goal of EOL care. The DCS has been validated in a Chinese population.
Measured: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.
Older adults and family caregivers' congruence in goal of EOL care
Congruence in goal of EOL care will be assessed by the dyad's response to a scenario case (DSC-2) separately "in the event that I (the older adult participant) am in the terminal ill situation …." Each member of the dyad will independently choose one of three options: "the goals of care should be focused on prolonging my (his/her) life, no matter what it may cost," "b. the goals of care should be focused on my (his/her) comfort and peace, even though it may not extend life" or "I am not sure." The responses will be stratified and compared to assess the degree of congruence between older adults and family caregivers.
Measured: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.
Older adults' completion of AD documentation
Older adults' completion of AD documentation will be measured by reviewing participants' medical records for a new AD document during the study follow-up period.
Measured: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months(T3) post intervention .
Older adults' health service utilization
Older adults' health service utilization will be measured by participant self-reports of the number and duration of unplanned ER visits and hospital admissions.
Measured: 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.
Older adults' and family caregivers' baseline characteristics
Older adults' and family caregivers' baseline characteristics will be assessed by a survey on demographics, disease information, previous ACP-related experience, social support, and mental and physical health status.
Measured: before the intervention (T0)
Older adults and family caregivers' experience with the Nurse Navigation Program
The older adults and family caregivers will be interviewed together about their experience and perception of the intervention, the logistics of the intervention, and how it could be improved in the future. The interview questions will include: 1) What was your overall feeling about the NNP? 2) Tell me your opinion of the NNP's impact on your ACP decision-making. 3) Which parts of the NNP were the most or least helpful? 4) How did you benefit from participating in the NNP? 5) What are the NNP's limitations? 6) What changes need to be made to render the NNP more helpful for future participants?
Measured: 3-month (T1) post intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 Oct 2023
- Study start14 Dec 2023
- Primary completion31 Jul 2026 (estimated)
- Study completion31 Jul 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Older AdultsStudies of the same condition, open and under way.
- More trials run by The University of Hong KongThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 300 participants (estimated)
Sponsor and investigators
- Lead sponsor
- The University of Hong Kong
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Professor Chia-Chin Lin, The University of Hong Kong
- Investigators
- Chia-Chin LIN, PhD,FAAN,RN, Principal investigator, University of Hong Kong, School of Nursing
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06090240
- Sponsor's protocol ID
- IRB-2023-150, HKWC-2023-342
- Status last verified
- May 2026
- First submitted
- 13 Oct 2023
- Last updated
- 2 Jun 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 2 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Maximizing Teachable Moments: Motivational Interviewing (MI) to Enhance Advance Care Planning (ACP) for Older Adults and Caregivers After Emergency Visits - A Mixed-Method Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT06090240
- Acronym / sponsor ID
- IRB-2023-150, HKWC-2023-342
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 300 participants (estimated)
- Lead sponsor
- The University of Hong KongUniversity, hospital or other
- Study start
- 14 Dec 2023 (actual)
- Primary completion
- 31 Jul 2026 (estimated)
- Study completion
- 31 Jul 2027 (estimated)
- First posted
- 19 Oct 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study aims to evaluate the effectiveness of a motivational interviewing (MI) intervention in enhancing advance care planning (ACP) among older adults who have visited the Emergency Room (ER) in the past six months and their family caregivers. The main question it aims to answer is: The effectiveness of the MI-based ACP intervention implemented within six months of an ER visit on improving older adults' advance directives (AD) completion rate.
Compared to participants in the control group who will only receive a self-education booklet, participants in the intervention group will receive a motivational interview educational intervention to see the effectiveness of an MI-based ACP intervention implemented within six months following an emergency room visit regarding the completion of AD for older adults.
Detailed description
Targeted issue: At present no feasible method exists to empower older adults following ER visits to engage in ACP in Hong Kong.
Population: The target group will be dyads comprising older adults who have had ER visits within the previous six months and their family caregivers.
Intervention: An MI-based ACP intervention our team developed.
Main study aim: To investigate the effectiveness of an MI-based ACP intervention implemented within six months following an emergency room visit on completion of AD for older adults compared to a self-education group.
Study method: Investigators will recruit eligible participants from two largest public hospitals, including the geriatric outpatient clinic of Queen Mary Hospital (IRB Ref: UW23-402) and the accident \& emergency department of Queen Elizabeth Hospital (IRB Ref: KC/KE-23-0058/ER-1). A parallel RCT (allocation ratio= 1:1) with a post-trial qualitative study will be adopted and three follow-up time points at 3-, 6- and 12-month post-intervention. Participants in the intervention group will receive a dyadic motivational interview educational intervention, while participants in the comparison group will receive the pictorial ACP educational booklet for self-learning only. Patients unable to nominate a family caregiver will receive the elderly alone motivational interview educational intervention. Completion of AD and health service utilization will be assessed at three follow-up time points. In addition, a post-intervention interview, regarding stakeholders' views on the relevance, effectiveness, and experience of the intervention., will be conducted.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Dyadic motivational interviewing advance care planning (MI-ACP) | Experimental | Behavioral: Dyadic MI-ACP interventionOlder adult-family member dyads in this arm will receive an MI-based education intervention our team developed. |
| Self-learning | No intervention | –Older adult-family member dyads in this arm will receive a self-learning ACP educational material developed by the Hong Kong Hospital Authority. |
| Elderly alone MI-ACP | Experimental | Behavioral: Elderly alone MI-ACPOlder adults in this arm will receive an MI-based education intervention our team developed. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (7 listed)
- Aged 65 or older
- At least one episode of ER visit in the last six months
- Has a family caregiver to be present during the intervention
- Able to communicate in Chinese
- Aged 18 or above
Key exclusion criteria (6 listed)
- Has completion of an AD
- Moderate to severe cognitive impairment or diagnosis of dementia, as identified in health records
- Communication problems (e.g., deafness or aphasia)
- Moderate to severe cognitive impairment
- Communication problems (e.g., deafness or aphasia)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Dyadic MI-ACP interventionMotivational Interviewing on Advance Care Planning Intervention: Dyads of older adults and family caregivers will receive three MI-based ACP counselling sessions: (1) a preparatory session, (2) motivation session, and (3) planning session. The preparatory session will take 10-15 minutes, and the following two sessions in weeks 2 and 3 will last 30-45 minutes each. Before each session, the nurse interventionist will first assess the dyad's readiness to engage in ACP based on the state of change algorithm. Participants who have never thought about ACP will be in the pre-contemplation state, those who are willing to discuss EOL care and preferences to be in the contemplation state, those ready to talk about EOL planning to be in the preparation state, and those in the action state have a confirmed action plan on signing up their ADs. Readiness-based ACP goals will be established, and state-matched MI counseling will be customized for each participant. | Behavioural | Dyadic motivational interviewing advance care planning (MI-ACP) |
| Elderly alone MI-ACPOlder adults in this arm will receive an MI-based education intervention our team developed. | Behavioural | Elderly alone MI-ACP |
Primary outcome
Older adults' readiness for ACP
Time frame: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.
Older adults' readiness for ACP (primary outcome) will be measured by the readiness subscales of the Advance Care Planning Engagement Survey (ACPES), which comprises 6 items rated on a 5-point Likert scale, ranging from 1 (worst outcome) to 5 (best outcome). A higher score indicates a higher readiness for ACP. It assesses an individual's readiness to sign official papers for health decision delegates and ADs and readiness to talk with family and physicians about EOL care, and has been validated in Hong Kong.
8 secondary outcomes
Family caregivers' readiness for ACP
Time frame: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.
Older adults' emotional perception of ACP
Time frame: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.
Older adults' and family caregivers' decisional conflict
Time frame: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.
Older adults and family caregivers' congruence in goal of EOL care
Time frame: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.
Older adults' completion of AD documentation
Time frame: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months(T3) post intervention .
Older adults' health service utilization
Time frame: 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.
Older adults' and family caregivers' baseline characteristics
Time frame: before the intervention (T0)
Older adults and family caregivers' experience with the Nurse Navigation Program
Time frame: 3-month (T1) post intervention
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Jun 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Chia-Chin LIN, PhD,FAAN,RN principal investigator
University of Hong Kong, School of Nursing
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Dyadic MI-ACP intervention and Elderly alone MI-ACP in people with Older Adults and Advance Care Planning, run by The University of Hong Kong at 1 site in Hong Kong.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 7 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 2 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Hong Kong. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Chia-Chin LIN, PhD,FAAN,RN (852-3917-6600, cclin@hku.hk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Older adults' readiness for ACP (time frame: before the intervention (T0), and 3-month (T1), 6-month (T2), and 12-months (T3) post intervention.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Jun 2026.