Facilitating advance care planning in oncology: study protocol for the evaluation of a tailored implementation of an advance care planning tool (the INDEED study)

Abstract

Abstract Background Advance care planning (ACP) improves patient outcomes, but integration of ACP in daily practice for patients with cancer in hospitals remains suboptimal. Systematic implementation of tools to facilitate ACP could overcome the barriers for ACP. In this study we will evaluate the multifaceted tailored implementation of a digital ACP tool embedded in the electronic health record (EHR) in daily clinical cancer care. We will analyse the implementation process, its effect on use of the ACP tool, and the impact of use of the tool on healthcare use and healthcare costs. Methods We will perform a multicentre, convergent mixed-methods implementation study. The digital ACP tool supports healthcare professionals in conducting and documenting ACP conversations, and sharing this documentation with colleagues within and outside the hospital. The implementation will encompass four phases guided by the Implementation of Change model: 1) diagnostic analysis; 2) tailored implementation protocol development; 3) protocol implementation and testing; and 4) evaluation of the implementation process and its effects. We will evaluate both qualitative and quantitative aspects of the implementation process. Additionally, use of the tool and its impact on in-hospital healthcare use in the last three months of life and associated costs are measured. Discussion This study will provide knowledge on how to effectively implement ACP in routine care in hospitals for patients with cancer, by identifying effective implementation strategies. Furthermore, it will give insight in the effect of integration of ACP conversations in daily clinical care on healthcare use of patients with cancer in the last three months of life and the associated costs. Trial registration This study is registered at ClinicalTrials.gov (NCT06350968, Registration date: April 8, 2024).