OBJECTIVE: Advance Care Planning (ACP) - the communication process by which patients establish goals and preferences for future care - is encouraged to improve the quality of end-of-life care. Gaining insight into the views of elderly on ACP was the aim of this study, as most studies concern younger patients. METHODS: We conducted and analysed 38 semi-structured interviews in elderly patients with limited prognosis. RESULTS: The majority of participants were willing to talk about dying. In some elderly, however, non-acceptance of their nearing death made ACP conversations impossible. Most of the participants wanted to plan those issues of end-of-life care related to personal experiences and fears. They were less interested in planning other end-of-life situations being outside of their power of imagination. Other factors determining if patients proceed to ACP were trust in family and/or physician and the need for control. CONCLUSIONS: ACP is considered important by most elderly. However, there is a risk of pseudo-participation in case of non-acceptance of the nearing death or planning end-of-life situations outside the patient's power of imagination. This may result in end-of-life decisions not reflecting the patient's true wishes. PRACTICE IMPLICATIONS: Before engaging in ACP conversations, physicians should explore if the patient accepts dying as a likely outcome. Also the experiences and fears concerning death and dying, trust and the need for control should be assessed.
OBJECTIVE: Advance Care Planning (ACP) - the communication process by which patients establish goals and preferences for future care - is encouraged to improve the quality of end-of-life care. Gaining insight into the views of elderly on ACP was the aim of this study, as most studies concern younger patients. METHODS: We conducted and analysed 38 semi-structured interviews in elderly patients with limited prognosis. RESULTS: The majority of participants were willing to talk about dying. In some elderly, however, non-acceptance of their nearing death made ACP conversations impossible. Most of the participants wanted to plan those issues of end-of-life care related to personal experiences and fears. They were less interested in planning other end-of-life situations being outside of their power of imagination. Other factors determining if patients proceed to ACP were trust in family and/or physician and the need for control. CONCLUSIONS: ACP is considered important by most elderly. However, there is a risk of pseudo-participation in case of non-acceptance of the nearing death or planning end-of-life situations outside the patient's power of imagination. This may result in end-of-life decisions not reflecting the patient's true wishes. PRACTICE IMPLICATIONS: Before engaging in ACP conversations, physicians should explore if the patient accepts dying as a likely outcome. Also the experiences and fears concerning death and dying, trust and the need for control should be assessed.
Authors: Annicka G M van der Plas; Julia E A P Schellekens; Jolien J Glaudemans; Bregje D Onwuteaka-Philipsen Journal: BMC Geriatr Date: 2022-07-05 Impact factor: 4.070
Authors: Susan E Hickman; Alexia M Torke; Greg A Sachs; Rebecca L Sudore; Qing Tang; Giorgos Bakoyannis; Nicholette Heim Smith; Anne L Myers; Bernard J Hammes Journal: J Am Geriatr Soc Date: 2021-03-24 Impact factor: 7.538
Authors: Simon N Etkind; Anna E Bone; Natasha Lovell; Irene J Higginson; Fliss E M Murtagh Journal: J Am Geriatr Soc Date: 2018-03-07 Impact factor: 5.562
Authors: Ruth Piers; Gwenda Albers; Joni Gilissen; Jan De Lepeleire; Jan Steyaert; Wouter Van Mechelen; Els Steeman; Let Dillen; Paul Vanden Berghe; Lieve Van den Block Journal: BMC Palliat Care Date: 2018-06-21 Impact factor: 3.234