Advance care planning and the older patient

Aw, Dent; Hayhoe, Benedict; Smajdor, Anna; Bowker, Lesley K.; Conroy, Simon; Myint, Phyo Kyaw

doi:10.1093/qjmed/hcr209

Cited by 49 publications

(40 citation statements)

References 26 publications

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“…For example, since the adoption of the Patient SelfDetermination Act in the USA in 1991, only 10% of patients have prepared AD (18). Similar rates of uptake have been reported in Germany (19), the Netherlands (20), and the United Kingdom (21). Rates are reportedly even lower in Australia, at 0.2% to 7.9% (22) and Spain (<1%) (23).…”

Section: What Exactly Are Acp and Ad?supporting

confidence: 79%

What are the ethical questions raised by the integration of intensive care into advance care planning?

Quenot¹,

Ecarnot²,

Meunier-Beillard³

et al. 2017

Ann. Transl. Med.

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A major goal of intensive care units (ICUs) is to offer optimal management, but for many patients admitted to the ICU, they are unlikely to yield any lasting benefit. In this context, the ICU physician remains a key intermediary, particularly when a decision regarding possible limitation or withdrawal of lifesustaining therapy becomes necessary. The possibility of admission to the ICU, and the type of care the patient would like to receive there, should be integrated into the healthcare project in agreement with the patient, regardless of the stage of disease that the patient suffers from. These dispositions should be recorded in the patient's file, and should respect the progressive nature of both the disease itself, and the discussions necessary in such complex situations. The ICU physician can serve as a valuable consultant for the treating physician, in particular to guide patient choices when formalizing their healthcare preferences in the form of advance care planning (ACP) or advance directives (AD). Ideally, the best time to address this issue is before the patient's clinical situation deteriorates towards an acute emergency, and providing complete and transparent information to inform the patient's choices.

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Section: What Exactly Are Acp and Ad?supporting

confidence: 79%

What are the ethical questions raised by the integration of intensive care into advance care planning?

Quenot¹,

Ecarnot²,

Meunier-Beillard³

et al. 2017

Ann. Transl. Med.

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“…In our cross‐sectional analysis undertaken over a 3‐day period, none of the 100 patients aged 80 years or above admitted to an acute hospital in Sydney had ACD available in their medical records. These data give further evidence of the infrequency of ACD among elderly hospitalised Australians despite policies and literature outlining the importance of such documents . The reason for this may be a low frequency of ACD completion by elderly people in the community, as well as a failure of pre‐existing ACD making their way into the medical record for hospitalised patients .…”

Section: Discussionmentioning

confidence: 88%

Single‐centre cross‐sectional analysis of advance care planning among elderly inpatients

Cheang

Finnegan

Stewart

et al. 2014

Internal Medicine Journal

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“…36 Some studies have explored levels of agreement between people with long-term illness and their family carers and indicate varying levels of concordance. 37 In a qualitative study of dyads involving heart failure, Retrum et al 38 found that lack of agreement could impair the ACP process.…”

Section: Discussionmentioning

confidence: 99%

Preferences for end-of-life care: A nominal group study of people with dementia and their family carers

2012

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Background:The wishes and preferences of people with dementia should inform decisions on future care. However, such decisions are often left to family carers and may not reflect those the person with dementia would have made for themselves. We know little about what influences agreement between people with dementia and their carers. Aim: To explore whether people with dementia and their carers were able to generate and prioritise preferences for end-of-life care. We examined whether carers influenced the choices made by the persons with dementia. Design: Nominal group technique. Setting/participants: People with dementia (n = 6), carers (n = 5) and dyads of people with dementia and carers (n = 6) attending memory assessment services. Methods: Three modified nominal group technique groups were conducted in five stages: (1) silent generation of ideas, (2) discussion, (3) further generation of ideas, (4) discussion and themeing and (5) ranking. The discussions were recorded, transcribed and analysed for thematic content using NVIVO8. Results: Quality of care, family contact, dignity and respect were ranked as significant themes by all groups. The analysis of transcripts revealed three main themes: quality of care, independence and control and carer burden. People with dementia had difficulty considering their future selves. Carers wanted much control at the end of life, raising issues of assisted dying and euthanasia. Conclusions: Wishes and preferences of people with dementia and their family carers may differ. To ensure the wishes of people with dementia are respected, their views should be ascertained early in the disease before their ability to consider the future is compromised.

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Advance care planning and the older patient

Cited by 49 publications

References 26 publications

What are the ethical questions raised by the integration of intensive care into advance care planning?

What are the ethical questions raised by the integration of intensive care into advance care planning?

Single‐centre cross‐sectional analysis of advance care planning among elderly inpatients

Preferences for end-of-life care: A nominal group study of people with dementia and their family carers

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