Peer-reviewed article

Messaging and Chatbot-Assisted Nursing Consultation (ChatACP) to Empower Family Members of Residents of Nursing Homes on Advance Care Planning: Protocol for a Mixed Methods Pilot Study.

Tongyao Wang, Ho Nee Chu, Pui Hing Chau, Xue Zhou, Chia-Chin Lin · 12 Aug 2026

Abstract

BACKGROUND: Advance care planning (ACP) involves proactive communication about end-of-life care preferences among patients, families, and health care 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 physician engagement, but few target family members specifically or use a theoretical framework. The transtheoretical model is particularly underused 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: This study aims to evaluate the feasibility, acceptability, and preliminary efficacy of a 10-day digital intervention (ChatACP) designed to empower family members to support care home residents in ACP. METHODS: An explanatory sequential mixed methods study using a pilot randomized controlled trial with a postintervention and 3-month assessment and a posttrial qualitative study will be conducted. Eligible family members (N=60) of care home residents from 6 homes will be enrolled. The intervention group will receive ChatACP, and the control group will receive a self-learning ACP pamphlet. The ChatACP intervention consists of 2 phases. Phase 1 includes a 10-day series of 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. RESULTS: This project was recommended for support in September 2025. Recruitment and data collection will commence in September 2026. 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 predefined progress criteria. Preliminary efficacy outcomes will be analyzed using a generalized mixed-effects model. CONCLUSIONS: The study will inform whether the 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. TRIAL REGISTRATION: ClinicalTrials.gov NCT07448649; https://clinicaltrials.gov/study/NCT07448649. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/94883.