Background Historically, the term Advance Care Planning (ACP) as opposed to Advance Directives (ADs) was first programmatically coined in 1994, emphasising a new focus on a comprehensive communication process between patients, their carers and their family, rather than on documents (ADs). However, there is no universal definition of ACP, and numerous authors employ the term with different implications. This becomes particularly apparent when attempting a systematic review of the effects of ACP.
Aim To suggest an operational definition of ACP.
Methods Analysis of literature retrieved from systematic reviews, and of selected web resources.
Results There is a wide range of ACP conceptions, ranging from not differentiating between ACP and ADs at all to a sophisticated systematic approach deeply embedded in the regional health care structure. The need for qualified professional facilitation in order to validate the ACP process is emphasised at varying degrees. A score system is suggested that awards one (obligatory) point for a professionally facilitated conversation on preferences for future health care, and up to 3 points each in the categories Who Talks?, What Is Talked About?, What Supports Valid Planning?, and What Comes Out Of It?
Discussion The ACP Intervention Score (ACPIS) allows to rate the process quality of any ACP Intervention, and to compare different ACP approaches, for example in the context of systematic reviews. Since sophistication and feasibility of ACP are inversely related, a relatively low ACPIS score may not be necessarily bad if it goes along with broad implementation.
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