Table 4 Central themes and questions asked in the Theory of Change stakeholder workshops

Workshop 1 and 2

a) Problem description

b) Introduction to ToC method and ground rules (e.g. “Everyone’s input is equally valid”, “Think outside the box”, “Give the facilitator time to write things down”, “Nothing that is written down is definitive. We are following an iterative process”)

c) The question to initiate reflection: “In an ideal world, what would need to happen for a successful implementation of ACP?”

Workshop 1

a) Agreement on impact: What is the fundamental change we want to see in the nursing home setting in Flanders? How will the Flemish nursing home community be different because of what we do?

b) Ceiling of accountability

c) The long-term outcomes of advance care planning in nursing homes

d) What are the intermediate preconditions that are necessary to produce the long-term outcomes? Why do we think a given precondition will lead to (or is necessary to) reach the one that follows it?

e) What contextual conditions or circumstances are necessary to achieve the preconditions?

f) Consensus concerning the chronological order of preconditions

Workshop 2

a) Presentation and discussion of the ToC map developed in workshop 1

b) Review and refinement of the ToC developed in workshop 1 and filling in the gaps: Is the ToC map presented here “feasible” (likely to work), “effective” and “sustainable”? Is the change logically displayed? Are there essential elements that are missing or that we should definitely consider or discuss?

c) Which interventions should be initiated to achieve the preconditions and the long-term outcome?