Implementing an Advance Care Planning Program in German Nursing Homes
Open accessAbstract
BACKGROUND: Advance Care Planning (ACP) is a systematic approach to ensure that effective advance directives (ADs) are developed and respected. We studied the effects of implementing a regional ACP program in Germany. METHODS: In a prospective, inter-regionally controlled trial focusing on nursing homes (n/hs), we compared the number, relevance and validity of new ADs completed in the intervention region versus the control region. Intervention n/h residents and their families were offered professional facilitation including standardized documentation. RESULTS: Data from 136 residents of three intervention n/hs were compared with data from 439 residents of 10 control n/hs over a study period of 16.5 months. In the intervention region, 49 (36.0%) participating residents completed a new AD over the period of the study, compared to 18 (4.1%) in the control region; these ADs included 30 ADs by proxy in the intervention region versus 10 in the control region. Proxies were designated in 94.7% versus 50.0% of cases, the AD was signed by a physician in 93.9% versus 16.7%, and an emergency order was included in 98.0% versus 44.4%. Resuscitation status was addressed in 95.9% versus 38.9% of cases (p<0.01 for all of the differences mentioned above). In the intervention region, new ADs were preceded by an average of 2.5 facilitated conversations (range, 2–5) with a mean total duration of 100 minutes (range, 60–240 minutes). CONCLUSION: The implementation of an ACP program in German nursing homes led, much more frequently than previously reported, to the creation of advance directives with potential relevance to medical decision-making. Future research should assess the effect of such programs on clinical and structural outcomes.
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Facilitated ACP can increase the number of meaningful and valid advance directives.
“facilitated ACP can increase the number of meaningful and valid ADs”
From A systematic review of the effects of advance care planning facilitators training programs. (2019) · cites this paper as [4]
Facilitated ACP can strengthen patient autonomy.
“strengthen patient autonomy”
From A systematic review of the effects of advance care planning facilitators training programs. (2019) · cites this paper as [4]
Facilitated ACP can improve the quality of care when EOL is near.
“improve the quality of care when EOL is near [4–6]”
From A systematic review of the effects of advance care planning facilitators training programs. (2019) · cites this paper as [4]
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- Authors
- in der Schmitten, J., Lex, K., Mellert, C., Rothärmel, S., Wegscheider, K., & Marckmann, G.
- Affiliations
- University of Bonn (DE)
- Venue
- Deutsches Ärzteblatt international
- Publisher
- Deutscher Arzte-Verlag GmbH
- Published
- 2014-01-24
- Volume
- 111
- Issue
- 4
- Pages
- 50-7
- ISSN
- 1866-0452 (ISSN-L)
- PMC
- PMC3950824
- OpenAlex
- W310256205
- Cited by
- 100
- References
- 19
- Citations by year
- 2025: 7 · 2024: 4 · 2023: 2 · 2022: 6 · 2021: 15 · 2020: 15 · 2019: 9 · 2018: 11 · 2017: 4 · 2016: 14 · 2015: 9 · 2014: 4
- FWCI
- 10.28
- Type
- journal article
- Language
- de
- Open access
- green
- europepmc.org
- Locations
- Deutsches Ärzteblatt international (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- B. Braun-Stiftung
- Bundesministerium für Bildung und Forschung
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- advance care planning, advance directives, nursing homes, long-term care, proxy decision-making, resuscitation status, emergency orders, family involvement
- MeSH terms
- Aged, Aged, 80 and over, Female, Germany, Health Promotion, Humans, Male, Nursing Care, Nursing Homes, Patient Care Planning, Patient Education as Topic, Regional Health Planning, Terminal Care, Advance Directive Adherence, Advance Care Planning
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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