Implementing an advance care planning program in German nursing homes: results of an inter-regionally controlled intervention trial
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Implementing an advance care planning program in German nursing homes: results of an inter-regionally controlled intervention trial. / In der Schmitten, Jürgen; Lex, Katharina; Mellert, Christine; Rothärmel, Sonja; Wegscheider, Karl; Marckmann, Georg.
In: DTSCH ARZTEBL INT, Vol. 111, No. 4, 2014, p. 50-7.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Implementing an advance care planning program in German nursing homes: results of an inter-regionally controlled intervention trial
AU - In der Schmitten, Jürgen
AU - Lex, Katharina
AU - Mellert, Christine
AU - Rothärmel, Sonja
AU - Wegscheider, Karl
AU - Marckmann, Georg
PY - 2014
Y1 - 2014
N2 - 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.
AB - 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.
KW - Advance Care Planning
KW - Advance Directive Adherence
KW - Aged
KW - Aged, 80 and over
KW - Female
KW - Germany
KW - Health Promotion
KW - Humans
KW - Male
KW - Nursing Care
KW - Nursing Homes
KW - Patient Care Planning
KW - Patient Education as Topic
KW - Regional Health Planning
KW - Terminal Care
U2 - 10.3238/arztebl.2014.0050
DO - 10.3238/arztebl.2014.0050
M3 - SCORING: Journal article
C2 - 24612497
VL - 111
SP - 50
EP - 57
JO - DTSCH ARZTEBL INT
JF - DTSCH ARZTEBL INT
SN - 1866-0452
IS - 4
ER -
