Consensus views on advance care planning for dementia: a Delphi study.

Area of Science:

• Gerontology
• Neuroscience
• Bioethics

Background:

• Advance care planning (ACP) uptake is notably low in individuals with dementia.
• Communication barriers between professionals, patients, and families hinder ACP processes.
• Lack of consensus on how to conduct ACP contributes to low engagement.

Purpose of the Study:

• To investigate consensus views on explaining and implementing advance care planning (ACP) for people with dementia.
• To identify optimal timing, content, and participants for ACP discussions in dementia care.
• To explore reasons for low ACP rates and establish best practices.

Main Methods:

• A three-round Delphi study was employed to gather expert opinions.
• Participants included family members, old age psychiatrists, and policymakers.
• Consensus was sought on 32 items related to ACP for people with dementia.

Main Results:

• Consensus was reached on 11 key areas for ACP discussion.
• ACP is best initiated after diagnosis acceptance, when the individual is ready.
• Emphasis was placed on personal choice, autonomy, financial aspects, and spousal involvement.
• No consensus on mandatory professional involvement, though professionals are seen as key to low uptake.

Conclusions:

• Advance care planning (ACP) for dementia should integrate general values and specific points.
• Professionals should offer ACP discussions and information, respecting patient autonomy.
• Effective ACP requires addressing communication barriers and patient readiness.