Beratung zur Patientenverfügung

Petri, S.; Marckmann, Georg

doi:10.1055/s-0041-108100

Cited by 5 publications

(3 citation statements)

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“…As a result, there remains considerable ambiguity in the application of the AD‐Ps, resulting in uncertainty among healthcare professionals—and potential disregard of patients' (presumed) treatment preferences. Similar conceptual and application problems are also known for ADs, 11 although these tend to be more standardized in Germany due to the limited number of widely used, similarly worded AD forms 44 . The varying quality of ADs is indeed a major argument for a comprehensive, standardized, high‐quality approach to ACP that includes uniform documentation 11 …”

Section: Discussionmentioning

confidence: 99%

“…Similar conceptual and application problems are also known for ADs, 11 although these tend to be more standardized in Germany due to the limited number of widely used, similarly worded AD forms. 44 The varying quality of ADs is indeed a major argument for a comprehensive, standardized, high-quality approach to ACP that includes uniform documentation. 11 While the need for AD-Ps is most obvious for acute medical crises, it also seems advisable to plan ahead for non-emergency medical decisions like artificial nutrition in the case of a deteriorating patient with dysphagia.…”

Section: Discussionmentioning

confidence: 99%

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Advance care planning by proxy in German nursing homes: Descriptive analysis and policy implications

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Jox

Pentzek

et al. 2021

J American Geriatrics Society

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Background: Legally recognized advance directives (ADs) have to be signed by the person to whom the decisions apply. In practice, however, there are also ADs written and signed by legal proxies (surrogates) on behalf of patients who lack decision-making capacity. Given their practical relevance and substantial ethical and legal implications, ADs by proxy (AD-Ps) have received surprisingly little scientific attention so far.Objectives: To study the form, content, validity, and applicability of AD-Ps among German nursing home residents and develop policy implications. Methods: Secondary analysis of two independent cross-sectional studies in three German cities, comprising 21 nursing homes and 1528 residents. The identified AD-Ps were analyzed in parallel by three independent raters. Interrater agreement was measured using free-marginal multi-rater kappa statistics.Results: Altogether, 46 AD-Ps were identified and pooled for analysis. On average (range), AD-Ps were 1 (1-7) year(s) old, 0.5 (0.25-4) pages long, signed by 1 (0-5) person, with evidence of legal proxy involvement in 35%, and signed by a physician in 20% of cases. Almost all the AD-Ps reviewed aimed to limit life-sustaining treatment (LST), but had widely varying content and ethical justifications, including references to earlier statements (30%) or actual behavior (11%). The most frequent explicit directives were: do-not-hospitalize (67%), do-not-tube-feed (37%), do-notattempt-resuscitation (20%), and the general exclusion of any LST (28%). Inter-rater agreement was mostly moderate (kappa ≥0.6) or strong (kappa ≥0.8).Conclusions: Although AD-Ps are an empirical reality in German nursing homes, formal standards for such directives are lacking and their ethical justification based on substituted judgment or best interest standard often remains unclear. A qualified advance care planning process and corresponding documentation are required in order to safeguard the appropriate use of this important instrument and ensure adherence to ethico-legal standards.See related editorial by Cohen et al.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Advance care planning by proxy in German nursing homes: Descriptive analysis and policy implications

Schmitten

Jox

Pentzek

et al. 2021

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…Insgesamt gibt es in Deutschland eine Vielzahl verschiedener Vordrucke für Patientenverfügungen, die häufig aus dem Internet heruntergeladen werden. Daneben gibt es zahlreiche Beratungsangebote von einzelnen Personen oder Organisationen, die jedoch hinsichtlich der Inhalte sehr heterogen sind [2].…”

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