1286 Enhancing confidence of dementia family surrogates in decision-making through ACP: a pilot RCT

<h3>Background</h3> Experts recommend an approach to advance care planning (ACP) that prepares individuals and surrogates to make in-the-moment decisions, not just simply making instructional advance directives. Surrogates of dementia patients often face challenges in making decisions for loved ones who may not have previously expressed their wishes. Little is known about approaches that can increase surrogates’ decision-making confidence. <h3>Methods</h3> We conducted a pilot randomized controlled trial to assess a novel ACP intervention that aims to improve dementia family surrogates’ decision-making confidence. The intervention, guided by Bandura’s Self-Efficacy Theory, consists of a structured nurse-facilitated ACP intervention and incorporates two video decision aids, one providing information about dementia disease trajectory and care decisions, the other providing vicarious learning through sharing experiences of other surrogates. Family surrogates of hospitalized advanced dementia patients were recruited and randomized 1:1 to ACP intervention or usual care after patient discharge. We assessed outcomes using the modified Family Member Decision-Making Self-Efficacy Scale and Family Distress in Advanced Dementia Scale at baseline, 2 months and 6 months with generalized linear mixed effects models. <h3>Results</h3> Fifty-eight surrogates were enrolled (29 per arm). In the ACP group, self-efficacy showed a non-significant increase at 2 months (β = 8.59, p = 0.08) and a significant increase at 6 months (β = 10.85, p = 0.04). In the control group, self-efficacy did not significantly change at 2 months (p=0.23) or 6 months (p=0.38). At 6 months, distress level significantly decreased in both ACP (p&lt;0.005) and control groups (p&lt;0.001). <h3>Discussion</h3> This study demonstrates that a structured nurse-facilitated ACP using video decision aids can enhance decision-making confidence among dementia surrogates without increasing distress. Further research is needed to assess the intervention’s broader impacts on both surrogates and patients. <h3>Unique Contribution</h3> This pilot RCT is among the first to evaluate the impact of a theory-driven ACP intervention on decision-making self-efficacy of surrogates for dementia patients. <h3>Implications</h3> The findings support integrating a structured, nurse-led ACP intervention with education and vicarious learning video decision-aids into clinical practice and ACP training of healthcare professionals. This approach could better prepare surrogates for decision-making, potentially leading to more informed and less stressful experiences.