# Development of a Collaborative Education Program for Home Care Nursing Educators’ on-the-Job Training in End-of-Life Home Care: Protocol for a Randomized Controlled Trial

## TL;DR

This study aims to develop and test an online training program to help home care nursing educators better train staff in end-of-life home care, overcoming time and location barriers.

## Contribution

The study introduces a novel collaborative online training program for home care educators focused on end-of-life care, delivered via internet and mobile messaging.

## Key findings

- The program includes three online sessions and weekly mobile messages to support educators.
- 120 participants were enrolled, with data collection completed by early 2026.
- Results are expected to support scalable training strategies in home care settings.

## Abstract

Despite the growing demand for end-of-life home care, nursing educators responsible for on-the-job training face substantial barriers, such as time and geographical constraints, which limit their access to professional development. Collaborative online training programs offer a potential solution to these challenges.

This study aims to develop and evaluate a collaborative online training program designed to improve the educational ability of home care nursing educators in delivering effective on-the-job training for home-based end-of-life care.

This parallel group, waitlist-controlled trial recruited home care nursing managers or educators from agencies with at least one home death client in the past year. We will provide this program on the internet. The intervention will comprise three online sessions, each lasting 60 minutes and held monthly, involving one lecture and two interactive case studies related to on-the-job training in end-of-life home care. This will be followed by 8 weeks of weekly educational messages via LINE, a mobile messaging app widely used in Japan. The control group will serve as a waitlist and will receive the same intervention after the control period. The primary outcomes are participants’ attitudes, measured using the End-of-Life Nursing Education Questionnaire. Using a centralized computer-generated randomization system, 125 home care nursing managers and educators will be recruited and randomly assigned to either the intervention or control group at a ratio of 1:1. Stratification will be based on their agency’s annual home death count between November 29, 2023, and November 29, 2024. To minimize performance bias, the intervention content has been standardized before the intervention to ensure fidelity.

This study was approved by the Ethics Committee of the Graduate School of Medicine, The University of Tokyo (2024359NI-(2)) on November 15, 2024. Participant recruitment began on November 29, 2024, and closed on December 25, 2024, with 120 participants enrolled. As of February 15, 2026, the following number of surveys were completed at each time point: 106 at T0 (the intervention group:the control group; 52:54); 103 at T1 (51:52); 102 at T2 (50:52); 40 at T3 and 43 at T4 in the intervention group; and 47 at T5, 44 at T6, and 41 at T7 in the control group. Quantitative data collection was completed by January 2026, and qualitative interviews will be completed by March 2026. Primary quantitative results and integrated results are expected to be submitted for publication in 2026-2027 and 2027-2028, respectively.

This protocol can address geographical and time constraints by providing flexible, online educational resources for home care nursing educators. The anticipated outcomes include enhanced on-the-job training ability among nursing educators for home-based end-of-life care. This study’s findings could support broader implementation of scalable training strategies in home care settings.