Document resource
Background Residents of nursing homes (NH) have a high risk of life-threatening illness. In Germany residents are only treated consistent with their well-informed preferences in around 1/5 of such situations. Advance Care Planning (ACP) facilitation and the resulting ACP documents aim to improve this in cases of loss of decision-making. For this improvement, it is relevant that medically relevant, meaningful and sufficiently detailed preferences are documented.Research Question What are the preferences of NH residents in the event of a life-threatening illness accompanied by loss of decision-making, if they are given the opportunity to develop these in an ACP facilitation?Method As part of the BEVOR trial, the existence of ACP documents (advance directives (AD) and AD-by proxy) in accordance with the standards of ACP Germany was recorded by trained facility staff from all resident files in the care facilities of the intervention group.Results In 2,343 residents, 348 documents guiding emergency care were found, 40% (152) of which were made by proxies. 25% (94) showed preference for purely palliative care in an acute life-threatening event, 61% (231) agreed to be hospitalised for life-sustaining therapy, 44% (168) to intensive care treatment and 16% (59) to resuscitation. In the case of hospital treatment with incapacity to consent of unclear duration, 20% (65) preferred only palliative care, 75% (246) made restrictions on treatments in the further course of the illness. In case of permanent incapacity to consent, 64% (211) preferred only palliative care, 34% (112) made differentiated restrictions on treatments.Conclusion In order to enable residents of NH to be treated according to their own preferences if they are unable to give consent, a differentiated analyses of various medical scenarios and the documentation of the preferences thus developed is necessary.Unique Contribution These results can help to make ACP facilitation more effective and improve the quality of patient-centred decision-making for life-sustaining treatments.Implications Our results show that detailed ACP facilitation is useful in NH, as residents used the opportunity to define their differentiated preferences depending on the medical situations.