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Dupont C, De Vleminck A, Deliens L, Gilissen J. Advance Care Planning in Belgium. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 180:121-126. [PMID: 37391298 DOI: 10.1016/j.zefq.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 07/02/2023]
Abstract
This paper aims to 1) describe current levels of Advance Care Planning (ACP) development since 2002 in Belgium, 2) report on challenges and opportunities to inspire other countries with similar contextual characteristics and 3) support further development of ACP practice and research in Belgium. To address these aims, we consulted local researchers, 12 domain experts and (grey) literature (regulatory documents, reports, policy documents and practice guidelines) on ACP, palliative care, and related healthcare topics. Since 2002, when the Patient's Right Law was passed in the federal Parliament, Belgium has had a specific medicolegal context for ACP. Initiatives to improve the uptake of ACP have been taken, e.g. standardised documentation, reimbursement codes for physicians provided by the government, and implementation of quality indicators in hospitals and nursing homes. Most of these initiatives are grassroots or predominantly oriented towards a single group of professions, e.g. general practitioners, disregarding the role that other professions can play. The patient groups most often targeted are those with cancer and older adults. Limited but growing attention is given to those with low health literacy or other minority groups. Main barriers to ACP in Belgium are: no unified platform to exchange outcomes of ACP discussions or advance directives between healthcare professionals and though efforts are made, ACP is still predominantly oriented towards documentation.
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Affiliation(s)
- Charlèss Dupont
- End-of-Life Care Research Group, Dept of Family Medicine & Chronic Care, Vrije Universiteit Brussel & Dept of Public Health and Primary Care, Universiteit Gent, Belgium.
| | - Aline De Vleminck
- End-of-Life Care Research Group, Dept of Family Medicine & Chronic Care, Vrije Universiteit Brussel & Dept of Public Health and Primary Care, Universiteit Gent, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Dept of Family Medicine & Chronic Care, Vrije Universiteit Brussel & Dept of Public Health and Primary Care, Universiteit Gent, Belgium
| | - Joni Gilissen
- End-of-Life Care Research Group, Dept of Family Medicine & Chronic Care, Vrije Universiteit Brussel & Dept of Public Health and Primary Care, Universiteit Gent, Belgium; Senior Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, USA
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Blot F, Fasse L, Mateus C, Renard P, Verotte N, de Jesus A, Dumont SN. [Implementation of a multimodal strategy for information and collection of advance directives in a comprehensive cancer center]. Bull Cancer 2023:S0007-4551(23)00133-9. [PMID: 36963998 DOI: 10.1016/j.bulcan.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION In France, advance directives (AD) remain unknown and underused by healthcare users and professionals. This is particularly true in oncology. This work was carried out with patients and caregivers of a Comprehensive Cancer Center to improve their appropriation and information. METHODS The project, built by the Ethics Committee, the Patients Committee and the Palliative Care Team, made it possible to develop over 6 months a training program, an information procedure and several original documents. RESULTS A total of 34 one-hour training courses for all professionals were organized. A procedure for making information available, including the right to draft ADs, has been implemented. This procedure is personalized, gradual and multi-professional. When a patient wishes to write his AD, he is accompanied by a dedicated team and benefits from a specific form, which enlighten values and preferences before addressing the desired level of therapeutic commitment. Communication elements were diffused, and a specific training on "anticipated discussions" was created. A dedicated space in the computerized chart makes it possible to locate the existence of ADs and to display them instantaneously. DISCUSSION - CONCLUSION: Based on the observation of the obstacles to the use of ADs, the strategy we implemented aims to provide information that is both efficient and ethically respectful for both patients and caregivers. ADs are only one element facilitating autonomy and anticipation, and must be associated with a shared continuous definition of the project and of the goals of care.
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Affiliation(s)
- François Blot
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Réanimation, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France.
| | - Léonor Fasse
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Unité de psycho-oncologie, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Christine Mateus
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Équipe mobile de soins palliatifs, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Perrine Renard
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Équipe mobile de soins palliatifs, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Nelly Verotte
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Direction des affaires juridiques, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Anne de Jesus
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Direction de la qualité, relation avec les usagers, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Sarah N Dumont
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Département de médecine oncologique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
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Silies KT, Köpke S, Schnakenberg R. Informal caregivers and advance care planning: systematic review with qualitative meta-synthesis. BMJ Support Palliat Care 2021; 12:bmjspcare-2021-003095. [PMID: 33952583 DOI: 10.1136/bmjspcare-2021-003095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Advance care planning (ACP) is a communication process about a person's values, life goals and preferences for current and future treatment and care. It can improve end-of-life care experiences for care recipients as well as for family caregivers. Knowledge about caregivers' needs might support implementation of ACP interventions suitable to both care recipients and their caregivers. OBJECTIVE To explore the experiences and attitudes of informal family caregivers, and their knowledge, regarding ACP. METHODS A systematic literature search was conducted (participants: family caregivers; intervention: advance care planning; databases: MEDLINE, PsycINFO, CINAHL, Cochrane Library). Thematic synthesis was applied to qualitative and mixed methods studies; quantitative studies were described in relation to the themes of the meta-synthesis. RESULTS 57 studies were included, of these 51 in the meta-synthesis. Three themes emerged: (1) caregiver's individual conceptualisation of ACP, (2) caregiver's relationships and (3) ACP process. These themes were incorporated into a longitudinal perspective on the caregiver's ACP trajectory, encompassing the phases (A) life before, (B) ACP process, (C) utilisation of ACP and (D) life after. The implications for ACP activities are described according to each phase. CONCLUSION For the benefit of care recipients, healthcare professionals should carefully consider caregivers' conceptualisations of ACP as well as the relationships within the family. They need to be skilled communicators, sensitive to individual needs and equipped with sufficient time resources to tailor ACP interventions to their clients' unique situation. Thus, they will support decision-making according to care recipients' wishes, caregivers' end-of-life experience and their life after bereavement. PROSPERO REGISTRATION NUMBER CRD42018082492.
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Affiliation(s)
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Rieke Schnakenberg
- Department for Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Dunleavy L, Walshe C, Machin L. Exploring the psychological impact of life-limiting illness using the Attitude to Health Change scales: A qualitative focus group study in a hospice palliative care setting. Eur J Cancer Care (Engl) 2020; 29:e13302. [PMID: 32881122 DOI: 10.1111/ecc.13302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/25/2020] [Accepted: 08/07/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Practitioners are often reluctant to engage in conversations that acknowledge patient's health concerns. This can affect patient and family carer psychological well-being. The Attitude to Health Change scales, adapted from the validated Adult Attitude to Grief scale, may have potential to address the psychological impact of illness and facilitate conversations in palliative care. To explore how health and social care professionals experience using the Attitude to Health Change Scales within hospice settings. METHODS Qualitative focus groups with practitioners currently using the Attitude to Health Change scales in three UK hospices. Two researchers conducted the interviews, developed the thematic framework and independently coded the transcripts using a framework analysis approach. RESULTS Three focus groups (n = 21 practitioners). The scale was used to assess and reassess levels of vulnerability and resilience to identify the need for support and to facilitate structured in-depth conversations. Factors that influenced scale implementation included the following: practitioner personal comfort and training; patient and family carer willingness to engage with the scales and having a practitioner "champion" within the organisation. CONCLUSION This exploratory work has identified the potential value of the scales for assessment and to facilitate conversations. Further research needs to incorporate the views of patients and family carers.
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Affiliation(s)
- Lesley Dunleavy
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Linda Machin
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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