Lena Werdecker1,2, Matthias Kujawa3, Nils Schneider4, Gerald Neitzke3. 1. Institut für Geschichte, Ethik und Philosophie der Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland. lena.werdecker@uni-wh.de. 2. Fakultät für Gesundheit, Institut für Integrative Gesundheitsversorgung und Gesundheitsförderung, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, Witten, 58448, Deutschland. lena.werdecker@uni-wh.de. 3. Institut für Geschichte, Ethik und Philosophie der Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland. 4. Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
Abstract
BACKGROUND: The Hospice and Palliative Care Act (2015) promotes advance care planning (ACP) for patients in nursing homes, but chronically ill patients living at home can also benefit from ACP. OBJECTIVE: The aim of the study was to analyze the perception of ACP consultations by patients with advanced heart failure. MATERIAL AND METHODS: Patients (70 years and older) with advanced heart failure participated in two physician-led ACP consultations. Afterwards, two evaluative interviews were conducted with each participant. All consultations and interviews were analyzed by grounded theory considering the coding paradigm. Finally, an empirical grounded typology was conducted. RESULTS: A total of 30 patients participated in at least 1 ACP consultation, whereas 18 persons completed an interview. Successful ACP consultations depend not only on the discussion but also on the patient's requirements: willingness to discuss ACP, their illness, death and dying, and the experienced and preferred role in healthcare decision-making. From the patient's viewpoint ACP consultation can result in an advance directive, but an informed rejection of ACP or the creation of new assumptions for the future are also possible outcomes. CONCLUSION: The ACP discussions should to be aligned to patients' preferences in terms of communication and content. It is important to accept a rejection of dealing with ACP or conducting an advance directive. The patients' view needs to be integrated into future research.
BACKGROUND: The Hospice and Palliative Care Act (2015) promotes advance care planning (ACP) for patients in nursing homes, but chronically ill patients living at home can also benefit from ACP. OBJECTIVE: The aim of the study was to analyze the perception of ACP consultations by patients with advanced heart failure. MATERIAL AND METHODS:Patients (70 years and older) with advanced heart failure participated in two physician-led ACP consultations. Afterwards, two evaluative interviews were conducted with each participant. All consultations and interviews were analyzed by grounded theory considering the coding paradigm. Finally, an empirical grounded typology was conducted. RESULTS: A total of 30 patients participated in at least 1 ACP consultation, whereas 18 persons completed an interview. Successful ACP consultations depend not only on the discussion but also on the patient's requirements: willingness to discuss ACP, their illness, death and dying, and the experienced and preferred role in healthcare decision-making. From the patient's viewpoint ACP consultation can result in an advance directive, but an informed rejection of ACP or the creation of new assumptions for the future are also possible outcomes. CONCLUSION: The ACP discussions should to be aligned to patients' preferences in terms of communication and content. It is important to accept a rejection of dealing with ACP or conducting an advance directive. The patients' view needs to be integrated into future research.
Entities:
Keywords:
Advance care planning; Advance directives; Palliative care; Qualitative research; Shared decision making
Authors: Mirjam Dieckelmann; Juliana J Petersen; Corina Güthlin; Felix Reinhardt; Jasper Plath; Klaus Jeitler; Thomas Semlitsch; Ferdinand M Gerlach; Andrea Siebenhofer Journal: BMJ Open Date: 2020-10-10 Impact factor: 2.692