Advance Care Planning in terminally ill and frail older persons

Abstract: Objective: Advance Care Planning (ACP) – the communication process by which patients establish goals and preferences for future care – is encouraged to improve the quality of end-of-life care. Gaining insight into the views of elderly on ACP was the aim of this study, as most studies concern younger patients. Methods: We conducted and analysed 38 semi-structured interviews in elderly patients with limited prognosis. Results: The majority of participants were willing to talk about dying. In some elderly, however, non-acceptance of their nearing death made ACP conversations impossible. Most of the participants wanted to plan those issues of end-of-life care related to personal experiences and fears. They were less interested in planning other end-of-life situations being outside of their power of imagination. Other factors determining if patients proceed to ACP were trust in family and/or physician and the need for control. Conclusions: ACP is considered important by most elderly. However, there is a risk of pseudo-participation in case of non-acceptance of the nearing death or planning end-of-life situations outside the patient''s power of imagination. This may result in end-of-life decisions not reflecting the patient''s true wishes. Practice implications: Before engaging in ACP conversations, physicians should explore if the patient accepts dying as a likely outcome. Also the experiences and fears concerning death and dying, trust and the need for control should be assessed. [Copyright &y& Elsevier]