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PP19.005 Concepts of advance care planning processes in different clinical settings: experiences from Switzerland
  1. Ulrike Elisabeth Ehlers1,2,
  2. Isabelle Karzig2,
  3. Tanja Krones2,
  4. Barbara Loupatatzis2,3 and
  5. Settimio Monteverde2,4
  1. 1Surgical Intensive Care Unit, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
  2. 2Clinical Ethics Unit, University Hospital of Zurich and University of Zurich, Institute of Biomedical Ethics and History of Medicine, Zurich, Switzerland
  3. 3Palliative Care Unit, Hospital Wetzikon, Wetzikon, Switzerland
  4. 4University of Applied Sciences, School of Health Professions, Bern, Switzerland


Background As discussed worldwide, Advance Care Planning (ACP) needs successful and feasible processes. Useful documentation needs to be viewed in relation to the specific healthcare context, as there are significant differences in clinical practice.

Methods In Switzerland, ACP is used as a standardized advance health care planning tool adapted to a variety of settings. We describe current concepts and experiences of ACP in three clinical settings: palliative care, short-term preoperative planning, and for emergency situations in an intensive care unit. We illustrate these by case examples from our everyday experience.

Results In palliative care units, there are usually multiple contacts between ACP facilitators and patients over time, creating a deeper bond. ACP needs can be elicited and adjusted through repeated conversations. The result can range from brief conversations in which the care goal of maximizing palliative care is clear to complex palliative emergency and end-of-life care planning.

In preoperative ACP conversations the focus lies on adapting and integrating ACP in relation to emergencies before or during interventions. Hypothetical questions about general advance health care planning and end-of-life care goals in the event of incapacity are less important and therefore less frequently discussed.

Acute situations are dominant in the intensive care unit (ICU) and quick decisions are required. ICU patients who are capable of judgment experience the consequences of their decisions directly. Opportunities for joint communication, information and decision-making are rare and must be seized.

Conclusions ACP is feasible as a standard of advance health planning done by trained ACP facilitators including physicians and nurses but must be adapted to various clinical circumstances and ACP processes. Content and documentation of ACP discussions depend on the time span from consultation to intervention, potential risk of future emergencies and capacity of decision-making.

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