Development of a Community Advance Care Planning Guides Program and the RELATE Model of Communication.
Carey Candrian, Susan Lasker Hertz, Daniel Matlock and 4 others
PMID 31030524WHAT IT FOUND
Trained laypeople guiding advance care planning conversations succeeded when they prioritized building rapport and listening over rushing to forms.
Participants felt heard and motivated to act when the guide adapted to their comfort level, whereas starting with paperwork often hindered connection.
Key findings
01Conversation partners valued feeling heard and understood, noting that guides who listened actively rather than just presenting information created a safer space for discussing end-of-life preferences.
02A major challenge identified was establishing sufficient rapport before asking intimate questions about illness and death, with some participants wishing the guide had spent more time on connection before moving to forms.
03Training in specific communication skills increased the lay guides' confidence, allowing them to ask permission before discussing sensitive topics, which helped conversation partners feel less pressured.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included a small number of participants (15 pairs). Conversation partners were existing hospice volunteers, which may not reflect the general public or patients who are more resistant to these conversations. The study was conducted in a single geographic location. Real-world conversations initiated by guides outside the training setting were not observed, so the study only evaluates the quality of conversations within the controlled evaluation phase.
The easy way to misread this
Do not interpret this as evidence that layperson-led programs improve clinical outcomes or advance directive completion rates. The study describes communication dynamics in a small, volunteer-heavy sample and did not measure whether these conversations led to actual healthcare system changes or patient outcomes.