In the 1990s advance care planning (ACP) developed as an alternative to the traditional approach to creating advance directives. In contrast to the traditional approach, the ACP concept views advance health care planning as a lifelong communication process. All persons in a target group are actively offered professional facilitation. Furthermore, the relevant institutions and professionals are involved and receive regular training and updates. They thus assume responsibility for ensuring that newly written advance directives are relevant, valid, available when needed, and honored reliably. In an article published in the latest issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2014; 111 (4): 50-57), Jürgen in der Schmitten and his co-authors describe the advantages of ACP over the traditional approach to creating advance directives.
They compared the data of 136 residents of three intervention nursing homes with those of 439 residents of ten control nursing homes. Over the course of the 16.5-month observation period, 49 (36%) of the participants in the intervention nursing homes completed new advance directives, compared with only 18 (4.1%) in the control nursing homes. A far higher proportion of the newly written directives in the intervention region were signed by a physician and provided clear instructions on how to proceed in an emergency.
The authors conclude that implementation of an ACP program in German nursing homes leads to much higher numbers of effective advance directives than has previously been the case. Classic advance directives, in contrast, are seldom to hand when needed, rarely relevant, of dubious validity, and are often disregarded by medical staff. Jürgen in der Schmitten and his co-authors urge greater attention to ACP and recommend further research.