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Advance Care Planning in terminally ill and frail older persons

, : Advance Care Planning in terminally ill and frail older persons. Patient Education and Counseling 90(3): 323-329

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. We conducted and analysed 38 semi-structured interviews in elderly patients with limited prognosis. 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. 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. 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.


PMID: 21813261

DOI: 10.1016/j.pec.2011.07.008

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