Chatbot-Assisted Advance Care Planning Education for Family Members (ChatACP)

Messaging-and-chatbot-assisted Nursing Consultation to Empower Family Members of Residents Living in Nursing Homes on Advance Care Planning (ChatACP)

The goal of this clinical trial is to learn if a messaging and chatbot program, called ChatACP, helps family members of people living in nursing homes take part in advance care planning.

The main questions this study aims to answer are:

• Does ChatACP help family members feel more ready to talk about future medical and personal care with their loved one?
• Does ChatACP help family members take part in advance care planning activities, such as having care discussions or completing planning documents?
• Is ChatACP easy to use and acceptable for family members?

Researchers will compare ChatACP to standard self-learning materials about advance care planning to see which approach works better.

Participants will:

• Receive short daily messages with pictures or videos about advance care planning and access to a chatbot specialized in ACP for 10 days
• Complete surveys at the start of the study, after the program ends, and again 3 months later
• Take part in an interview to share their experience with the program

Study Overview

• Status: Not yet recruiting
• Conditions: Advance Care Planning
• Intervention / Treatment: Behavioral: ChatACP - Messaging- and-Chatbot Assisted Nursing Consultation; Behavioral: ACP self- learning handout (Hong Kong Hospital Authority ACP education material)

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tongyao Wang; Phone Number: 85255968294; Email: tongyao1@hku.hk
• Study Contact Backup: Name: Qianqian Long; Phone Number: 85290614121; Email: yennilon@hku.hk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• aged 18 years or older
• providing care for an older adult (age 65 or above) living in a care home as a family member (including the family members in the traditional sense and the guardian and persons close to or significant to the older adult)
• able to read, write and communicate in Cantonese or Mandarin
• the resident, care recipient, having a prefrail or frail status as defined by a score of 3 or above on the Clinical Frailty Scale (CFS)
• having a mobile device to receive instant messages and access to cellular network
• engaged in minimal or no prior EOL care discussions with the care home resident as defined by a self-reported status of pre contemplation/contemplation stage on ACP discussions with the resident using the ACP staging algorithm

Exclusion Criteria:

• suffering from moderate to severe cognitive impairment defined by an Abbreviated Mental Test score of 5 or less and unable to give consent
• suffering from communication problems (e.g., deafness or aphasia)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: ChatACP Group	Behavioral: ChatACP - Messaging- and-Chatbot Assisted Nursing Consultation; The ChatACP for family members encompassed a digital education component and a care provider engagement component. The digital education component includes 10-day messages of ACP infographics, video clips, and a chatbot with specific content for ACP. The care provider engagement component includes one nurse-led telephone consultation.
Active Comparator: Control group (ACP self-learning)	Behavioral: ACP self- learning handout (Hong Kong Hospital Authority ACP education material); Participants in the control group will be provided with self-learning ACP education material created by the Hong Kong Hospital Authority for public education.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recruitment feasibility	Recruitment rate will be assessed by calculating the percentage of eligible family members who provide study consent and actively participate in the study.	From enrollment to 3-month follow-ups
Retention rate	The proportion of participants who successfully complete all surveys and interview for outcome measures and intervention effect outcomes.	From enrollment to 3-month follow-ups
Percentage of Intervention Components Delivered in Compliance with the Intervention Protocol	Fidelity refers to the extent to which core intervention components were delivered as planned by the research team. Delivery indicators include: Provision of assigned infographics Provision of assigned educational videos Respondent to inquiries Completion of scheduled nurse consultation sessions Fidelity will be calculated as: (Number of intervention components delivered as planned ÷ Total planned intervention components) × 100%. Higher percentages indicate greater adherence to the intervention protocol. Progression criterion: The intervention will be considered feasible if ≥90% of core intervention components are delivered in accordance with the protocol.	From enrollment to 3-month follow-ups
Participant Engagement Measured by Messaging Platform Interaction Logs and Self-Reported Message Reading Percentage	Participant engagement will be assessed using automatically recorded conversation logs from the messaging platform and chatbot system, as well as participant self-reported message reading extent. Engagement indicators include: Number of interactions (instant messages, phone calls, or chatbot) recorded in the messaging platform and chatbot logs;; Self-reported percentage of daily intervention messages read (0% = did not read any messages; 100% = read all assigned messages). Interaction frequency will be reported as counts per participant. Message reading extent will be reported as a percentage (0-100%). Higher interaction frequency and higher reading percentages indicate greater engagement with the intervention. Progression criterion: The intervention will be considered feasible if ≥50% of participants have at least one recorded interaction (via instant message, phone call, or chatbot) and report reading ≥50% of the daily intervention messages.	assessed at post-intervention (T1, immediately after completion of the intervention), based on usage data collected during the intervention period
Mean Score of the Perceived Infographic Usability Scale (0-100% per Item)	The scale evaluates message-delivered infographics across eight domains: Trustworthiness Clarity Risk of confusion Difficulty to follow Usefulness Informativeness Comprehensibility Simplicity Each item is rated using a 0-100% sliding scale (0 = lowest perceived usability; 100 = highest perceived usability). For each domain, the mean score will be calculated. Higher scores indicate better perceived usability of the infographic content. Progression criterion: The infographic content will be considered usable if the mean score for each domain is ≥78%.	post-intervention (T1, within 1 week after completion of the intervention), and 3 months post-intervention (T2)
Proportion of Participants Reporting High Satisfaction (Score 4-5) on all three items of the Investigator-Developed Acceptability Survey (5-Point Likert Scale)	Intervention acceptability will be assessed using an investigator-developed satisfaction survey. The survey evaluates three domains: Form of delivery; Availability of customized support for advance care planning (ACP) questions; Degree to which the intervention met participants' needs Each item is rated on a 5-point Likert scale: = Highly dissatisfied; = Dissatisfied; = Neither satisfied nor dissatisfied; = Satisfied; = Highly satisfied Scores range from 1 to 5 for each item. Higher scores indicate greater satisfaction and acceptability. Progression criterion: The intervention will be considered acceptable if ≥70% of participants score 4 or 5 on all three items	post-intervention (T1, within 1 week after completion of the intervention), and 3 months post-intervention (T2)
Intervention safety	Risk assessment will be conducted using self-reported adverse events.	From enrollment to 3-month follow-ups
Background questionnaire	The questionnaire includes demographics and care-related information.	at baseline (T0, prior to intervention)
Qualitative Findings on Feasibility and Acceptability of the Intervention Based on Semi-Structured Interviews	Semi-structured qualitative interviews will be conducted at 3-month follow-up using an interview guide developed by the Principal Investigator. Interviews aim to explore family caregivers' experiences with the intervention, including perceived acceptability, logistics, and suggestions for improvement. Interviews will be audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Findings will be reported as identified themes and representative quotations. Progression criteria: The intervention will be considered feasible if qualitative findings demonstrate overall positive perceptions regarding acceptability, logistics, and perceived usefulness of the intervention.	at 3-month post-intervention follow-up (T2)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chinese Version of the 10-item Family Members' ACP Readiness Questionnaire (Total Score, 10-50)	The Chinese version of the 10-item Family Members' Advance Care Planning (ACP) Readiness Questionnaire assesses family members' self-reported ACP knowledge, readiness to discuss ACP with a loved one, self-efficacy in initiating ACP conversations, perceived barriers, emotional perceptions and attitudes toward ACP, and perceived communication tools for ACP discussions. Each item is rated on a 5-point Likert scale (1-5). Total scores range from 10 to 50, calculated by summing all items. Higher scores indicate greater ACP readiness. The instrument was developed based on key domains reported in adult ACP readiness measures and constructs identified in a systematic review of family members' roles in ACP. The Chinese version has demonstrated good internal consistency (Cronbach's α = 0.86-0.90).	at baseline (T0, prior to intervention), post-intervention (T1, within 1 week after completion of the intervention), and 3 months post-intervention (T2)
Chinese Version of the 17-item Advance Care Planning Engagement Survey for Surrogate Decision Makers (Total Score, 17-85)	The Chinese version of the 17-item Advance Care Planning Engagement Survey for Surrogate Decision Makers assesses caregivers' engagement in the advance care planning (ACP) process. The instrument comprises 17 items rated on a 5-point Likert scale (1-5). Total scores range from 17 to 85, calculated by summing all items. Higher scores indicate greater engagement in the ACP process. The scale includes three domains: Serving as a surrogate decision maker (7 items), Contemplation (4 items), and Readiness (6 items). The instrument was adapted from the original 55-item ACP Engagement Survey and has been validated among surrogates of patients with chronic illness. The Chinese version has demonstrated high internal consistency (Cronbach's α = 0.90-0.91).	at baseline (T0, prior to intervention), post-intervention (T1, within 1 week after completion of the intervention), and 3 months post-intervention (T2)
Number of Participants Reporting Completion of Each of Six Advance Care Planning Activities	Participants will report a binary response ("Yes" or "No") to six advance care planning (ACP) behaviors widely used to evaluate ACP outcomes: Completion of a health care proxy;; Communication with the resident regarding views about life-sustaining treatment;; Communication with the resident regarding quality versus quantity of life;; Communication between the resident and healthcare providers regarding life-sustaining treatment;; Communication between the resident and healthcare providers regarding quality versus quantity of life;; Completion of end-of-life documentation, including documentation of ACP in medical records, Advance Medical Directive (AMD), or Do-Not-Attempt-Cardiopulmonary-Resuscitation (DNACPR) forms. For each activity, results will be reported as the number and proportion of participants selecting "Yes." A "Yes" response indicates that the specified ACP activity has been completed. A "No" response indicates that the activity has not been completed.	at baseline (T0, prior to intervention), post-intervention (T1, within 1 week after completion of the intervention), and 3 months post-intervention (T2)

Collaborators and Investigators

• Sponsor: The University of Hong Kong

Study record dates

Study Major Dates

• Study Start (Estimated): June 30, 2026
• Primary Completion (Estimated): June 30, 2028
• Study Completion (Estimated): June 30, 2028

Study Registration Dates

• First Submitted: February 8, 2026
• First Submitted That Met QC Criteria: February 26, 2026
• First Posted (Actual): March 4, 2026

Study Record Updates

• Last Update Posted (Actual): March 4, 2026
• Last Update Submitted That Met QC Criteria: February 26, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: UW25-567

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No