Accepted for/Published in: JMIR Research Protocols
Date Submitted: Mar 9, 2026
Open Peer Review Period: Mar 10, 2026 - Apr 29, 2026
Date Accepted: May 29, 2026
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Messaging-and-chatbot-assisted Nursing Consultation to Empower Family Members of Residents Living in Nursing Homes on Advance Care Planning : Protocol for a mixed-methods pilot study
ABSTRACT
Background:
Advance care planning (ACP) involves proactive communication about end-of-life care preferences among patients, families, and healthcare providers. In Chinese culture, older adults commonly delegate such care decisions to adult children, yet family reluctance—rooted in beliefs that aggressive treatments are beneficial—remains a major barrier to ACP participation. Existing interventions improve documentation and communication through education, hypothetical scenarios, and provider engagement, but few target family members specifically or employ a theoretical framework. The Transtheoretical Model (TTM) is particularly underutilized for assessing family readiness. Infographics, videos, and large language models demonstrate strong potential for engagement, highlighting the need for tailored, theory-driven family empowerment interventions.
Objective:
To evaluate the feasibility, acceptability, and preliminary efficacy of a 10-day digital ChatACP intervention designed to empower family members to support care home residents in ACP.
Methods:
An explanatory sequential mixed-methods study employing a pilot randomized controlled trial with a post-intervention and 3-month assessment and a post-trial qualitative study. Eligible family members (N=60) of care home residents from six homes will be enrolled. The ChatACP intervention consists of two phases. Phase 1 includes a series of 10-day ACP educational infographics, video clips, and a content-specific chatbot on ACP knowledge in Hong Kong. Upon completion of Phase 1, those not advancing to the action stage will receive Phase 2 of a nurse-led telephone consultation. The intervention group will receive the ChatACP. The control group will receive a self-learning ACP pamphlet.
Results:
Primary outcomes of feasibility and acceptability include rates of recruitment, retention, fidelity, engagement, usability, and safety. Secondary outcomes include the family members’ ACP readiness, engagement, and completion of ACP activities. The feasibility and acceptability outcomes will be compared to the predefined progress criteria. Preliminary efficacy outcomes will be analyzed using a generalized mixed-effect model.
Conclusions:
The study will inform whether ChatACP intervention can empower families on ACP. Findings from this study can inform the development of large-scale interventions to improve ACP engagement among family members of care home residents. Clinical Trial: ClinicalTrials.gov identifier: NCT07448649. Date of Registration: March 4, 2026
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