Rocambolesco- current and future models of advance care planning

Taubert, Mark ORCID: https://orcid.org/0000-0003-0454-5609, Rietjens, Judith and Korfage, Ida 2020. Rocambolesco- current and future models of advance care planning. Presented at: 11th EAPC World Research Congress, Palermo, Italy, 7-9 October 2020. Palliative Medicine. , vol.34 (1_Supp) SAGE, p. 95. 10.1177/0269216320958098

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Abstract

Aims: There is an increased global focus on advance care planning (ACP). We look at current evidence, barriers and facilitators, and how this area will best integrate those individuals who lack decisional capacity from the outset. We try to analyse the trends of what ACP may look like in years to come Methods: We conducted a rapid review of the literature to analyse the barriers and facilitators to ACP in different contexts, and how culture impacts on acceptability of ACP. Different models were analysed, including examples from Europe (e.g. Future Care Planning in Wales) and current work in Asia (e.g. dementia programs). Results: Despite evidence on the positive effects of ACP, the frequency of ACP conversations between patients and health care professionals today still remains low in clinical practice settings. For instance, research in chronic respiratory disease showed that while many patients and their health care professionals are interested in engaging in ACP, only 12%–32% patients reported having had such conversations. There may be a discrepancy between the expressed interest in engaging in ACP and the extent to which ACP actually occurs. Research has demonstrated significant barriers to ACP. Recent studies also highlight barriers to ACP uptake which relate to cultural factors. A review showed that non-white ethnicity is associated with lower acceptability of formal ACP, at least in the USA. “Western” understanding of autonomy may not be wholly applicable in Asian cultures where autonomy is often understood to be relational rather than individual. Conclusion: Current models of ACP stress that it is a process. They range in the extent to which healthcare professionals play a central role in facilitating this process. Several models are designed to support clinicians in their ACP conversations, using standardized, structured conversation guides. An analysis of 34 available clinician conversation guides showed that such guides usually focus on an exploration of patient's perspectives on illness, living well, end-of-life issues, and decision making. In many models, ACP conversations are held by trained facilitators that are not necessarily clinicians. But increasingly, internet programs like Prepare For Your Care support the ACP process, especially in the initial stages. With the emergence of Artificial Intelligence to support decision making, people will be able to gain more of an understanding before they make advance decisions. Future advance care planning is likely to be a ‘rocambolesco’ (Italian for adventurous) pastiche of contemporary practices.

Item Type:	Conference or Workshop Item (Poster)
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	SAGE
ISSN:	0269-2163
Last Modified:	09 Nov 2023 02:10
URI:	https://orca.cardiff.ac.uk/id/eprint/137322

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