Advance care planning discussions with geriatric patients

Advance care planning discussions are conversations with patients about future treatment to ensure that the patients' wishes are known if their decision-making capacity fails. Many doctors fear that such conversations represent a strain on patients. We wished to test systematic advance care planning discussions on an acute geriatric ward and to investigate how patients felt about such discussions.

All patients who were admitted were continuously assessed with regard to their capacity for reflection on their future illness. An internationally tested tool was used as a basis for discussion with willing patients.

Of 96 patients who were assessed, a total of 34 were found to be unsuitable and four declined. Of the 58 interviewed, 54 wanted complete transparency of information and 47 wanted their families to participate when important information was to be imparted and crucial decisions on treatment were to be made. A total of 11 wanted no involvement of their families in these processes. All of them wanted their doctor to participate in important decisions. The majority took a very positive view of an advance care planning discussion of this type. Only one had a negative attitude.

The patients were overwhelmingly positive with regard to advance care planning discussions. They have important messages to convey about information, the involvement of their families and the intensity of end-of-life treatment.