title: A cluster randomized controlled trial on the effects and costs of advance care planning in elderly care: study protocol.
abstract: BACKGROUND
  Currently, health care and medical decision-making at the end of life for older people are often insufficiently patient-centred. In this trial we study the effects of Advance Care Planning (ACP), a formalised process of timely communication about care preferences at the end of life, for frail older people.
  
  
  METHODS
  We will conduct a cluster randomised controlled trial among older people residing in care homes or receiving home care in the Netherlands. The intervention group will receive the ACP program Respecting Choices® in addition to usual care. The control group will receive usual care only. Participants in both groups will fill out questionnaires at baseline and after 12 months. We hypothesize that ACP will lead to better patient activation in medical decision making and quality of life, while reducing the number of medical interventions and thus health care costs. Multivariate analysis will be used to compare differences between the intervention group and the control group at baseline and to compare differences in changes after 12 months following the inclusion.
  
  
  CONCLUSIONS
  Our study can contribute to more understanding of the effects of ACP on patient activation and quality of life in frail older people. Further, we will gain insight in the costs and cost-effectiveness of ACP. This study will facilitate ACP policy for older people in the Netherlands.
  
  
  BACKGROUND
  Nederlands Trial Register: NTR4454.
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. i.korfage@erasmusmc.nl.
authors.forename: Ida J
authors.initials: IJ
authors.lastname: Korfage
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. j.rietjens@erasmusmc.nl.
authors.forename: Judith A C
authors.initials: JA
authors.lastname: Rietjens
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. a.overbeek@erasmusmc.nl.
authors.forename: Anouk
authors.initials: A
authors.lastname: Overbeek
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. l.jabbarian@erasmusmc.nl.
authors.forename: Lea J
authors.initials: LJ
authors.lastname: Jabbarian
authors.affiliation: Laurens, Rotterdam, The Netherlands. p.billekens@laurens.nl.
authors.forename: Pascalle
authors.initials: P
authors.lastname: Billekens
authors.affiliation: Gundersen Lutheran Medical Foundation, La Crosse, WI, USA. bjhammes@gundersenhealth.org.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Hammes
authors.affiliation: Laurens, Rotterdam, The Netherlands. e.hansen@laurens.nl.
authors.forename: Ellen
authors.initials: E
authors.lastname: Hansen-van der Meer
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. s.polinder@erasmusmc.nl.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Polinder
authors.affiliation: Laurens, Rotterdam, The Netherlands. j.severijnen@laurens.nl.
authors.forename: Johan
authors.initials: J
authors.lastname: Severijnen
authors.affiliation: Laurens, Rotterdam, The Netherlands. s.swart@laurens.nl.
authors.forename: Siebe J
authors.initials: SJ
authors.lastname: Swart
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. f.witkamp@erasmusmc.nl.
authors.forename: Frederika E
authors.initials: FE
authors.lastname: Witkamp
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. a.vanderheide@erasmusmc.nl.
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
mesh_terms: D032722:Advance Care Planning / Q000191:economics / Q000458:organization & administration; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D006299:Health Services for the Aged / Q000191:economics / Q000592:standards; D006801:Humans; D008297:Male; D009426:Netherlands; D057240:Patient Preference; D018802:Patient-Centered Care / Q000379:methods*; D058996:Quality Improvement; D011788:Quality of Life; D011795:Surveys and Questionnaires