Controlled follow-up survey of qualified advance directives two years after implementation of an ACP program. Issue 2 (1st June 2012)

• Record Type: Journal Article
• Authors: In Der Schmitten, J; Mellert, C; Wegscheider, K; Marckmann, G
• Is Part Of: BMJ supportive & palliative care. Volume 2:Issue 2(2012)
• Page Start: 192
• Page End: 193
• Publication Date: 2012-06-01
• Subjects: Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/bmjspcare-2012-000250.84
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Background: Implemented in 02/2009, the German regional ACP program beizeiten begleiten ® ('be caring betimes'), based on Respecting Choices®, has demonstrated a moderate effect on the distribution of advance directives in the intervention region's nursing homes. In a follow-up study, we examined whether the effect was sustained and increasing over time. Methods: Two years after the intervention (04/2011), in a cross-sectional controlled follow-up survey we compared written AD's of all live residents and a random sample of recently (since 1.7.10) deceased residents of the three co-operating nursing homes (n/hs) of our intervention region with corresponding random samples of similar size among the residents of 8 n/hs in our control regions. Primary endpoint is the prevalence of qualified ADs; an AD was regarded qualified if it included a decision on CPR, and carried a physician's signature. AD status of 235 live and 35 recently deceased residents in the intervention region was compared with that of 279 live and 36 deceased residents in the control region. Results: In the comparison between intervention and control region, 56.7% vs. 26.0% had any written AD, 42.6% vs. 1.3% had an AD regarded helpful in case of sudden cardiac arrest, 38.3 vs. 5.7% were signed by a physician, and 37.8% vs. 0.6% fulfilled both criteria (p<0.001 for all comparisons). Conclusion: The data confirm a sustained and relevant effect of the regional ACP program's implementation whereas qualified AD's seem rare exceptions elsewhere in German nursing homes.