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 Nicholson is a clinical academic nurse who champions Palliative Care For ALL. She holds a chair in Palliative Care and Ageing within the School of Health Science, University of Surrey and a Visiting professor at St Christopher’s Hospice London.
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 leads a research programme focussed supporting older people and their carers to live AND die well over a life long-lived. https://www.surrey.ac.uk/living-and-dying-well-research She is particularly interested in the transitions that occurs in the last phase of life and supporting integrative services and structures to enable care closer to home. She has published extensively in the field of frailty including co-editing the BGS guidance on end of life and frailty for clinicians across the multi-disciplinary team. She is a core re member of the European Association for Palliative Care Reference group on Ageing and Palliative Care and Faculty member of the International Fellowship in Palliative Care. 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.
Research groups and centres
Our research is supported by research groups and centres of excellence.