Background ACP programs allow patients to express their doubts, fears and preferences about end-of-life care, but often focus on documents instead of communication process. Health workers view ACP in a very positive light but they do not feel adequately trained to have these discussions.
Aim To promote ACP with chronic patients and to improve doctors and nurses’ training in ACP.
Methods Bottom-up project about ACP with chronic patients, people older than 75 and patients that could die in the next year. Semi-structured interviews in the primary care setting with patients, relatives, doctor and/or nurse and a ACP facilitator.
Results 279 patients (59% female, mean age 66) participated in 386 interviews (mean duration 42 min) from 1–10–2013 to 1–10–2014. An Advance Directive was drafted in 65% of cases. ACP information was given to 418 people (relatives included). Patients are afraid of pain and suffering but also of loss of autonomy or becoming a burden on the family. They prefer to be cared for at home, except in cases where people that live alone or do not have adequate support from the family. Most of them would like to donate organs after death if it were possible.
Conclusion Eliciting conversations with patients about end-of-life care is easier if it is not focused on documents and is performed in a primary care setting with their doctor and nurse who they know and trust. The ACP facilitator initiates the conversation, clarifies any doubts, is responsible for the training and simplifies the process of documentation.
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