Advance Care Planning in Belgium and The Netherlands: A Nationwide Retrospective Study Via Sentinel Networks of General Practitioners

Abstract

Context. Advance care planning (ACP) is an important part of patient-centered palliative care. There have been few nationwide studies of ACP, especially in Europe.Objectives. To investigate the prevalence and characteristics of ACP in two European countries and identify the associated factors.Methods. A mortality follow-back study was undertaken in 2007 via representative nationwide Sentinel Networks of general practitioners (GPs) in Belgium and The Netherlands using similar standardized procedures. All GPs reported on each non-suddenly deceased patient in their practice. Our main outcome measure was whether or not ACP, that is, an agreement for medical treatment and/or medical decisions in the last phase of life in the case of the patient losing competence, was present.Results. Among 1072 non-sudden deaths, ACP was done with 34% of patients and most often related to the forgoing of potential life-prolonging treatments in general (24%). In 8% of cases, ACP was made in consultation with the patient and in writing. In 23% of cases, care was planned with the patient's family only. Multivariate analysis revealed that ACP was more often made with patients if they were capable of decision making during the last three days of life (odds ratio [OR] 3.86; 95% confidence interval [CI] 2.4e6.1), received treatment aimed at palliation in the last week (OR 2.57; 95% CI 1.6e4.2), had contact with a GP in the last week (OR 2.71; 95% CI 1.7e4.1), died of cancer (OR 1.46; 95% CI 1.1e2.0), or died at home (OR 2.16; 95% CI 1.5e3.0).

Advance Care Planning in palliative care: A systematic literature review of the contextual factors influencing its uptake 2008–2012

“…Over half (13) of the included studies used qualitative methodology such as interviews and focus groups. Three studies employed mixed methodology such as surveys combined with interviews or open-ended questions.…”

“…11 The goal of optimising quality of life during incurable illness is also a central tenet of palliative care, and ACP allows the differing preferences of individuals to be identified, documented and enacted. [12][13][14] This synergy of purpose has driven interest in embedding ACP as a fundamental aspect of palliative care. 15,16 Accordingly, ACP in palliative care has been focused upon in international conferences, national health policy in several countries and the popular media.…”

Perspectives of Family Members on Planning End-of-Life Care for Terminally Ill and Frail Older People

“…10e12 Family members are often consulted in end-of-life care decisions, 13 and a high percentage of medical decisions are made by surrogates. 14,15 Some research has explored the perspectives of family members regarding decisionmaking. 14,16e21 A few studies revealed patterns or types of decision-making and showed that relatives have varying preferences in terms of level and scope of involvement in decisionmaking.…”

Implication insuffisante des médecins généralistes lors des décisions de limitation et/ou d’arrêt des traitements au sein d’un service de réanimation

“…Conformément à ce qui a été décrit [8], les MGs de notre étude s'estimaient pour la plupart disponibles (78,1 %) et compétents (81,2 %) pour participer à ce type de décision. Tout comme leurs collègues réanimateurs, deux études ont montré que les MGs étaient régulièrement amenés à prendre en ville des décisions de LAT pour leurs patients [9,10]. Ces constatations vont dans le sens des dernières recommandations du Conseil national de l'ordre des médecins et de la Société de réanimation de langue française (SRLF) [11][12][13] : les MGs semblent être parmi ceux les plus aptes à endosser ce rôle de consultant défini par la loi pour les personnes inconscientes hospitalisées en réanima-tion.…”