Evaluation of a novel educational intervention for mental health staff on advance care planning with older people with mental illness

PURPOSE: To evaluate a novel educational intervention for mental health clinicians and peer workers on Advance Care Planning (ACP). The aims of the intervention were to improve staff knowledge, attitudes, and confidence in facilitating ACP with older people with mental illness and increase staff engagement in ACP. METHODS: A pre-post-intervention study was conducted across two public mental health services in Australia. Multidisciplinary clinicians and peer workers (n = 110) participated in a one-hour, evidence-informed educational session combining theory, video demonstrations, and discussion of case vignettes. Uniquely, this study utilized purpose-developed audio-visual resources designed for local legal frameworks and engagement of peer workers as both educators and participants. Paired pre- and post-intervention questionnaires assessed staff knowledge, attitudes, and confidence. A pre-post-audit of mental health consumer (patient) electronic medical records (eMR) quantified changes in ACP documentation rates. Thematic analysis of free-text feedback was conducted. RESULTS: The intervention significantly improved staff attitudes (p < 0.001, r = 0.48), knowledge (p < 0.001, r = 0.51), and confidence (p < 0.001, r = 0.87). However, eMR audits (pre: n = 1104; post: n = 1118) with a 2-3-month follow-up period revealed no significant change in ACP documentation rates (7.6% vs. 8.0%). Participants' feedback highlighted a desire for further practical training incorporating experiential learning (e.g., role-play) and systemic support. CONCLUSIONS: While a brief, standalone educational intervention significantly improved staff readiness for ACP, this did not translate into documented changes in clinical practice (eMR documentation). Bridging this knowledge-to-practice gap requires multifaceted strategies beyond standalone education, such as organizational governance, audit-feedback cycles, skills practice, and champions to embed ACP into routine practice.