Implementing an Advance Care Planning Program in German Nursing Homes

Schmitten, Jürgen in der; Lex, Katharina Maria; Mellert, Christine; Rothärmel, Sonja; Wegscheider, Karl; Marckmann, Georg

doi:10.3238/arztebl.2014.0050

Cited by 59 publications

(61 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This observation corresponds with the clinical and practical experience gained in other studies 1,2,21,24. This discovery also supports the efforts undertaken in pilot projects to offer support in the decision-making process to the elderly in retirement homes, and to chronically ill people, regarding medical treatments (including emergency care) 12,13,25. Yet, younger people also benefit from guidance in drawing up ADs.…”

Section: Discussionsupporting

confidence: 85%

See 1 more Smart Citation

Intricate decision making: ambivalences and barriers when fulfilling an advance directive

Schröder¹,

Hommel²,

Sahm³

2016

PPA

View full text Add to dashboard Cite

BackgroundDespite a recent statutory ruling stating the binding nature of advance directives (ADs), only a minority of the population has signed one. Yet, a majority deem it of utmost importance to ensure their wishes are followed through in case they are no longer able to decide. The reasons for this discrepancy have not yet been investigated sufficiently.Patients and methodsThis article is based on a survey of patients using a well-established structured questionnaire. First, patients were asked about their attitudes with respect to six therapeutic options at the end of life: intravenous fluids, artificial feeding, antibiotics, analgesia, chemotherapy/dialysis, and artificial ventilation; and second, they were asked about the negative effects related to the idea of ADs surveying their apprehensions: coercion to fulfill an AD, dictatorial reading of what had been laid down, and abuse of ADs.ResultsA total of 1,260 interviewees completed the questionnaires. A significant percentage of interviewees were indecisive with respect to therapeutic options, ranging from 25% (analgesia) to 45% (artificial feeding). There was no connection to health status. Apprehensions about unwanted effects of ADs were widespread, at 51%, 35%, and 43% for coercion, dictatorial reading, and abuse, respectively.ConclusionA significant percentage of interviewees were unable to anticipate decisions about treatment options at the end of life. Apprehensions about negative adverse effects of ADs are widespread.

show abstract

Section: Discussionsupporting

confidence: 85%

“…For this reason, some authors consider the institution of ADs to have failed 11–13. Only by means of considerable effort, and in specifically selected groups, can the number of people who finally write an AD be increased 12,14,15…”

Section: Introductionmentioning

confidence: 99%

Intricate decision making: ambivalences and barriers when fulfilling an advance directive

Schröder¹,

Hommel²,

Sahm³

2016

PPA

View full text Add to dashboard Cite

show abstract

“…Over half (20/37) of the studies were conducted in the USA, 22,25,[28][29][30][31]39,41,42,45,[47][48][49][50][52][53][54][55][56][57] nine were conducted in the UK, 26,[32][33][34][35]37,40,43,44 two were conducted in Australia 23,24 and one study was conducted in each of Germany, 46 Belgium, 38 Switzerland, 51 the Netherlands, 16 Singapore 36 and Saudi Arabia. 27 …”

Section: Settingmentioning

confidence: 99%

“…46,47 Two studies were assessed as providing strong evidence, 24,40 12 were assessed as providing moderate evidence 16,22,23,29,30,[35][36][37][38]54,55,57 and 23 were assessed as providing weak evidence. [25][26][27][28][31][32][33][34]39,[41][42][43][44][45][46][47][48][49][50][51][52][53]56 REVIEW OF PUBLISHED EVIDENCE NIHR Journals Library www.journalslibrary.nihr.ac.uk…”

Section: Quality Of Evidencementioning

confidence: 99%

See 1 more Smart Citation

Do-not-attempt-cardiopulmonary-resuscitation decisions: an evidence synthesis

Perkins

Griffiths

George

et al. 2016

Health Serv Deliv Res

View full text Add to dashboard Cite

BackgroundCardiac arrest is the final common step in the dying process. In the right context, resuscitation can reverse the dying process, yet success rates are low. However, cardiopulmonary resuscitation (CPR) is a highly invasive medical treatment, which, if applied in the wrong setting, can deprive the patient of dignified death. Do-not-attempt-cardiopulmonary-resuscitation (DNACPR) decisions provide a mechanism to withhold CPR. Recent scientific and lay press reports suggest that the implementation of DNACPR decisions in NHS practice is problematic.Aims and objectivesThis project sought to identify reasons why conflict and complaints arise, identify inconsistencies in NHS trusts’ implementation of national guidelines, understand health professionals’ experience in relation to DNACPR, its process and ethical challenges, and explore the literature for evidence to improve DNACPR policy and practice.MethodsA systematic review synthesised evidence of processes, barriers and facilitators related to DNACPR decision-making and implementation. Reports from NHS trusts, the National Reporting and Learning System, the Parliamentary and Health Service Ombudsman, the Office of the Chief Coroner, trust resuscitation policies and telephone calls to a patient information line were reviewed. Multiple focus groups explored service-provider perspectives on DNACPR decisions. A stakeholder group discussed the research findings and identified priorities for future research.ResultsThe literature review found evidence that structured discussions at admission to hospital or following deterioration improved patient involvement and decision-making. Linking DNACPR to overall treatment plans improved clarity about goals of care, aided communication and reduced harms. Standardised documentation improved the frequency and quality of recording decisions. Approximately 1500 DNACPR incidents are reported annually. One-third of these report harms, including some instances of death. Problems with communication and variation in trusts’ implementation of national guidelines were common. Members of the public were concerned that their wishes with regard to resuscitation would not be respected. Clinicians felt that DNACPR decisions should be considered within the overall care of individual patients. Some clinicians avoid raising discussions about CPR for fear of conflict or complaint. A key theme across all focus groups, and reinforced by the literature review, was the negative impact on overall patient care of having a DNACPR decision and the conflation of ‘do not resuscitate’ with ‘do not provide active treatment’.LimitationsThe variable quality of some data sources allows potential overstatement or understatement of findings. However, data source triangulation identified common issues.ConclusionThere is evidence of variation and suboptimal practice in relation to DNACPR decisions across health-care settings. There were deficiencies in considering, discussing and implementing the decision, as well as unintended consequences of DNACPR decisions being made on other aspects of patient care.Future workRecommendations supported by the stakeholder group are standardising NHS policies and forms, ensuring cross-boundary recognition of DNACPR decisions, integrating decisions with overall treatment plans and developing tools and training strategies to support clinician and patient decision-making, including improving communication.Study registrationThis study is registered as PROSPERO CRD42012002669.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract

Ethisches Spannungsfeld – Vorausverfügen des Willens – Vertrauen auf Fürsorge

Treff¹

2022

Springer Reference Pflege – Therapie – Gesundheit

View full text Add to dashboard Cite

Implementing an Advance Care Planning Program in German Nursing Homes

Cited by 59 publications

References 17 publications

Intricate decision making: ambivalences and barriers when fulfilling an advance directive

Intricate decision making: ambivalences and barriers when fulfilling an advance directive

Do-not-attempt-cardiopulmonary-resuscitation decisions: an evidence synthesis

Ethisches Spannungsfeld – Vorausverfügen des Willens – Vertrauen auf Fürsorge

Contact Info

Product

Resources

About