CLaD 2.0 - Conversations on living and dying: Facilitating advance care planning with older people living with advancing frailty
Overview
Advance care planning (ACP) enables people nearing the end of life to talk about what matters most to them, including their preferred future care. It is particularly important for older people living with frailty as they are vulnerable to sudden health changes, but this group are rarely engaged with ACP conversations.
The CLaD 2.0 study builds on the Conversations on Living and Dying intervention. Developed by a team of researchers working with older people with frailty, unpaid carers, health and social care professionals, and patient and public involvement (PPI), CLaD supported care professional to facilitate ACP conversations with older people living with frailty.
This study moves the original intervention forward. Working with older people with frailty and those important to them, we will co-produce resources specifically designed to support older people with frailty to engage with ACP. Co-production will happen through a workshop and, to reduce burden on attendees, the research team and PPI representatives will use this data to develop the resources. The resources will then be tested in practice with care staff and older people with frailty and refinements made.
Research question
What educational and preparatory resources are required to support older people living with advancing frailty to engage with ACP?
Aim
To co-produce resources with older people living with advancing frailty to increase ACP engagement.
Resources
This study co-designed two leaflets to support older people living with advancing frailty to talk about and engage with advance care planning. The resources were created based on findings from the original study, a co-production session with unpaid carers and unpaid carer representatives of people living with frailty across London and the South East, and refined with patient and public representatives.
The aim of the resources are to support older people living with frailty, and their unpaid carers, to talk about what matters most to the older person, so that the person can plan their care - both now and in the future.
- Download the leaflet produced for older people themselves (PDF)
- Download the leaflet designed for unpaid carers of older people living with frailty (PDF)
Please do let us know if you have any feedback on these resources by emailing sarah.combes@surrey.ac.uk
Further information
For more information on the CLaD or CLaD 2.0 studies please contact Sarah Combe at sarah.combes@surrey.ac.uk or see below:
- Read about the CLaD intervention
- Read about the importance of living well now and relationships when engaging older people with frailty in advance care planning
- Read about the need for a systemwide approach when implementing advance care planning with community-dwelling frail elders.
Funder
Team
Study team
Dr Sarah Combes
Research Fellow
Biography
Sarah Combes is a clinical academic nurse specialising in palliative and end of life care for older people living with advancing frailty, dementia, and multiple long-term conditions. She holds dual roles as a Research Fellow at the University of Surrey and NIHR Senior Research Leader: Nursing and Midwifery at St Christopher’s Hospice.
With a background in leadership, change management, and education across sectors, Sarah brings a systems-level perspective to translational research. Her focuses is on decision-making and workforce development to support people nearing the end of life.
Prior to moving to Surrey, Sarah's was awarded a prestigious HEE/NIHR Clinical Doctoral Research Fellow which she completed at King’s College London. Her PhD focused on developing a behaviour change intervention to support health and social care professionals to better instigate and support advance care planning with older people living with advancing frailty. Sarah continues this work through What matters most? A study using co-production methodologies to support meaningful conversations with older people in the last phase of life. Sarah is also the Research Fellow on In the Driving Cessation Decision Seat, a study testing the feasibility and acceptability of a driving decision aid for people with dementia within UK memory services.
Sarah’s previous studies have focused on improving home-based palliative care for older people with advancing frailty, and building regional partnerships to improve end-of-life care coordination across community settings.
Dr Vanessa Abrahamson
Post-Doctoral Research Fellow (UoK)
See profile
Professor Caroline Nicholson
Professor of Palliative Care and Ageing
Biography
Caroline is a Clinical Academic Nurse and her research forwards understanding and care for older people living with complex needs. She is particularly interested in the transitions that occurs in the last phase of life. Caroline qualified as a Registered Nurse at St Bartholomew’s Hospital London. She worked as a specialist Palliative Care Nurse before undertaking a combined BSc (Hons) in Community Nursing DN/HV Certs at King’s College London. She went on to an MSc in Medical Anthropology at Brunel University London before completing her PhD at City University, London in 2009. She is a FHEA from the Institute of Education and holds a diploma in psycho-dynamic approaches to old age from the Tavistock and Portman NHS Foundation Trust, London
Caroline is a HEE/NIHR Senior Clinical Academic Lecturer, working between the School of Health Sciences at Surrey University and St Christopher’s Hospice, London. She is passionate in her belief that everyone should have access to the best care and support in the final years of their life. She has a long-held interest in the experiences and palliative care needs of older people and their families and is co-lead in End of life Care for the British Geriatrics Society.
Caroline studies the experiences and care of older people living with complex needs across care settings, to develop interventions which equally value quality of life with quantity of years in old age. She has a long-held interest in the experience of older people living with frailty, and their capabilities as well as their current and future vulnerabilities. Her work also includes the development of care services and a workforce that can recognize, facilitate and enhance the processes and outcomes of high-quality palliative and supportive care. Caroline is committed to building the next generation of clinical academics and is an NIHR Nurse Training Advocate . Research expertise includes participatory action research, narrative research, mixed method research and complex intervention development.
Research groups and centres
Our research is supported by research groups and centres of excellence.