RT Journal Article
SR Electronic
T1 Controlled follow-up survey of qualified advance directives two years after implementation of an ACP program
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP 192
OP 193
DO 10.1136/bmjspcare-2012-000250.84
VO 2
IS 2
A1 In Der Schmitten, J
A1 Mellert, C
A1 Wegscheider, K
A1 Marckmann, G
YR 2012
UL http://spcare.bmj.com/content/2/2/192.5.abstract
AB Background: Implemented in 02/2009, the German regional ACP program beizeiten begleiten® (‘be caring betimes’), based on Respecting Choices®, has demonstrated a moderate effect on the distribution of advance directives in the intervention region's nursing homes. In a follow-up study, we examined whether the effect was sustained and increasing over time. Methods: Two years after the intervention (04/2011), in a cross-sectional controlled follow-up survey we compared written AD's of all live residents and a random sample of recently (since 1.7.10) deceased residents of the three co-operating nursing homes (n/hs) of our intervention region with corresponding random samples of similar size among the residents of 8 n/hs in our control regions. Primary endpoint is the prevalence of qualified ADs; an AD was regarded qualified if it included a decision on CPR, and carried a physician's signature. AD status of 235 live and 35 recently deceased residents in the intervention region was compared with that of 279 live and 36 deceased residents in the control region. Results: In the comparison between intervention and control region, 56.7% vs. 26.0% had any written AD, 42.6% vs. 1.3% had an AD regarded helpful in case of sudden cardiac arrest, 38.3 vs. 5.7% were signed by a physician, and 37.8% vs. 0.6% fulfilled both criteria (p<0.001 for all comparisons). Conclusion: The data confirm a sustained and relevant effect of the regional ACP program's implementation whereas qualified AD's seem rare exceptions elsewhere in German nursing homes.