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How international experts would define advance care planning: a content analysis
Jenny T van der Steen1, Emma J de Wit2, Mandy Visser3
1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands; Radboudumc Alzheimer Center and Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands; Cicely Saunders Institute, King's College London, London, UK.
Annals of Palliative Medicine
|September 23, 2024
Summary
International experts define advance care planning (ACP) as person-centered conversations about future care choices. This broad definition emphasizes patient values over end-of-life specifics or documentation.
Area of Science:
- Medical Ethics
- Geriatric Medicine
- Health Communication
Background:
- Advance care planning (ACP) has shifted towards exploring broad patient values and preferences.
- International practices in ACP are diverse, necessitating a clear, shared understanding.
- Defining ACP is crucial for consistent implementation, especially in dementia care.
Purpose of the Study:
- To explore how international experts define advance care planning (ACP).
- To determine if expert definitions of ACP differ by medical profession.
- To identify core components of ACP definitions from a global perspective.
Main Methods:
- An explorative study using baseline data from a Delphi study on ACP in dementia.
- Experts (n=87) from 30 countries provided one-sentence definitions of ACP.
- Content analysis was used to categorize definition elements and assess phrasing perspectives (patient, professional, neutral).
Main Results:
- Nearly half of experts (45%) defined ACP from a patient perspective; 29% were neutral, 26% professional.
- Key definition categories included 'Choosing between options,' 'Care and treatment,' 'Planning for the future,' 'Individual person,' and 'Having conversations.'
- End-of-life and documentation were less frequently mentioned components. Definitions did not significantly differ between physicians and other healthcare professionals.
Conclusions:
- International experts commonly conceptualize ACP as person-centered conversations focused on future care and treatment choices.
- The expert consensus emphasizes broad values and preferences, not solely end-of-life issues or documentation.
- Future research should examine the integration of this conceptualization into clinical practice and recommendations.
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