Development and implementation of an advance care planning program in Catalonia, Spain

Abstract

ObjectiveImplementation of an advance care planning (ACP) program for people with advanced chronic conditions is a complex process. The aims of this paper are to describe (1) the development of the ACP program in Catalonia, Spain, for patients with advanced chronic conditions and complex needs and (2) the preliminary results of the implementation of this program in health and social services.MethodThe ACP program was developed and implemented in a four-stage process as follows: (1) design and organization of the project; (2) selection of the professionals to carry out the project; (3) creation of four working groups to develop the conceptual model, guidelines, training program, and perform a qualitative evaluation; and (4) project implementation.ResultThe following deliverables were completed: (1) conceptual framework document; (2) practical guidelines for the application of the ACP; (3) online training course (3,763 healthcare professionals completed the online course, with an overall satisfaction rating of 8.4 on a 10-point scale); and (4) additional training activities (conferences, short courses, and seminars) in between 2015 and 2017.Significance of resultsThis project was led by the Catalan Ministry of Health. The strengths of the project development include the contribution of a wide range of professionals from the entire region, approval by the Catalan Bioethics Committee and the Social Services Ethics Committee, and the ongoing validation by members of the community. A standardized online training course was offered to all primary care professionals and included as a quality indicator for continuing education for those professionals in the period 2016–2020. The main outcome of this project is the establishment of a pragmatic ACP throughout the region and training of the health and social care professionals involved in the care of advanced chronic patients.

Primary Care Professionals’ Self-Efficacy Surrounding Advance Care Planning and Its Link to Sociodemographics, Background and Perceptions: A Cross-Sectional Study

“…The ACP-SEs scale shows an overall mean of 65.90 (SD = 16.01) out of 100, with no statistically significant differences between doctors and nurses. Of the 19 items, 7 show significant differences between doctors and nurses (6,7,8,14,15,16,17,19). Doctors scored higher on all of these except item 19.…”

“…In Spain, recent initiatives have emerged to promote the development of ACP. For example, the ACP model of Spain's Catalonia region was established within the framework of the 2011-2015 health plan and started in 2014 [19]. Some key aspects of this project included a consensus of experts about the concept of ACP, a practical guide to ACP for clinical practice, and a training programme, including a 10 h online course and face-to-face workshops lasting from 4 to 8 h [19].…”

“…For example, the ACP model of Spain's Catalonia region was established within the framework of the 2011-2015 health plan and started in 2014 [19]. Some key aspects of this project included a consensus of experts about the concept of ACP, a practical guide to ACP for clinical practice, and a training programme, including a 10 h online course and face-to-face workshops lasting from 4 to 8 h [19]. In addition, a dedicated section for documenting the ACP process was added to the medical record of complex chronic patients and advanced chronic patients.…”

“…Considering the importance of recording the ACP process, the Catalan model of ACP defined the ACP as a recurring continuity improvement cycle, divided into six phases. One phase was to record preferences and other medical decisions explored in an ACP process as part of the medical record [19]. However, the low quality and accuracy of this documentation in Catalonia are currently areas for improvement, especially considering the ACP record's potential impact on patient safety [25].…”

Chair ICO/UVIC-UCC of palliative care at the University of Vic – Central University of Catalonia: an innovative multidisciplinary model of education, research and knowledge transfer

“…ACP has been identified as one of the main challenges for the implementation of the advanced chronic care model in Catalonia. To respond to this challenge, a comprehensive programme has been designed and implemented by the Department of Health (DoH) and led by the CPC 13. The programme started in 2013, and it includes the elaboration of a consensus policy document and educational activities including practical recommendations for the ACP process, an online course, workshops, massive open online courses (MOOCs) and research.…”