33 Empowering the aged care workforce in advance care planning: the role of mentorship and trust

<h3>Background and Aim</h3> Advance Care Planning (ACP) is critical for ensuring that residents in Residential Aged Care Facilities (RACFs) receive goal-concordant end-of-life care. However, workforce challenges and a lack of trust and partnership between families and staff, contributes to crisis-driven decisions. This study examines how a theory-informed Complex Intervention (CI), improves workforce capability in ACP. <h3>Methods</h3> A three-phase sequential explanatory mixed methods design was employed, integrating: Quantitative: Organisation Surveys (n=48), Nurse Education Survey (n=109), Decedent Audit Data (n=604), and Bereaved Satisfaction Survey (n=56) Qualitative: Focus Groups (nurse managers, n=12); Thematic analysis identified empowerment, trust, confidence, and relational mechanisms as critical enablers of effective and sustainable ACP. <h3>Results</h3> The intervention significantly improved ACP process (p &lt; .001), completion (p = .008) and use of documents to guide care (p &lt; .001). This increased engagement with ACP and alignment with care preferences (p &lt; .001), led to fewer crisis-driven decision-making including ED presentations and hospital admissions in the last 7 days of life (p = .005). Residents were more likely to have access to anticipatory PRN medicines (p = .006) and an increase in cessation of inappropriate interventions and observations in the terminal phase (p &lt; .001). Findings highlight that even highly competent and confident staff cannot prevent crisis-driven decision-making if a trusting partnership with families has not been established. The EPM intervention demonstrated that ACP is not solely technical skills but relational processes requiring early and sustained engagement. Facilities where staff actively built trust through consistent, proactive conversations with families saw fewer distress-driven hospital transfers at end of life, compared to those where ACP was introduced reactively. This reinforces the need for ACP to be framed as relational, not just clinical, interventions. <h3>Unique Contribution</h3> This study provides novel empirical evidence on how structured mentorship, embedded within the Empowered Partnerships Model (EPM), bridges the gap between ACP policy and frontline implementation. Unlike previous interventions that focus solely on ACP education, this approach integrates relational trust-building and systems-level reinforcement, ensuring sustainable workforce capability. <h3>Implications for Policy and Practice</h3> Findings support the integration of mentorship-driven ACP education within RACF workforce development strategies that recognising trust and partnership-building as core components of ACP competency. By investing in structured ACP mentorship and relational trust-building, RACFs can reduce hospital transfers, improve end-of-life outcomes, and empower staff to lead ACP discussions confidently. The EPM provides a scalable framework to strengthen ACP workforce capability across RACF settings.