The ACP-ASC model: A comprehensive behaviour change model for advance care planning based on the Stages of Change model.

Abstract

To design and implement interventions that promote advance care planning, behaviour change models can be useful. A widely used model is the Transtheoretical model by Prochaska and DiClemente (1982), describing five Stages of Change: precontemplation, contemplation, preparation, action, and maintenance. However, this model does not fully accommodate the advance care planning process. First, advance care planning can include not one, but ideally up to three actions: discussing wishes with family/friends, with healthcare professionals, and documentation. Second, the order of these actions can vary, and each action can be omitted. Third, advance care planning is an ongoing process in which individuals ideally reflect upon their wishes regularly; therefore, maintenance should be considered as part of action. To develop a comprehensive behaviour change model for advance care planning based on the Stages of Change: the Advance Care Planning-Applied Stages of Change model (ACP-ASC model). The ACP-ASC model is based on current literature and data from a nationwide sample of older people. It was conceptualized through extensive discussions within a multidisciplinary research team, including healthcare professionals.Insights:To accommodate the complexity of advance care planning, the action stage of the ACP-ASC model distinguishes three types of advance care planning actions (discussions with family/friends, with healthcare professionals, and documentation) and does not prescribe an order. Further, maintenance is incorporated in the action stage, resulting in levels of action (first; maintained) for each type of advance care planning action. Last, we discuss further considerations, practice implications, and recommendations for future research.