HOW INTERNATIONAL EXPERTS DEFINE ADVANCE CARE PLANNING: A CONTENT ANALYSIS

Innovation in Aging, vol. 8, pp. 254

Abstract

Abstract Planning for future medical care, referred to as Advance Care Planning (ACP), has evolved to a focus on conversations that explore values and preferences in a broad sense. It is unclear how this conceptualization has been adopted internationally, given diverse practices. Therefore, we examined how experts from across the globe define ACP and whether this differs by profession. In an explorative study embedded in a Delphi study on ACP in dementia, experts in ACP in persons with dementia and other diseases reported at baseline how they define ACP “in one sentence, off the top of your head.” We analyzed reported definitions with content analysis, created codes to identify definition elements, then merged them into categories. Almost half (45%) of 87 experts from 30 countries phrased ACP from a patient perspective (29% neutral, 26% professional). Codes (131) were merged into 19 categories. Five categories appeared in more than half of the definitions: ‘Choosing between options’, ‘Care and treatment’, ‘Planning for the future’, ‘Individual person’ and ‘Having conversations.’ ‘End of life’ and ‘Documenting’ were mentioned by a minority of experts. The definition of categories and perspectives did not appreciably differ between physicians and other professions. In conclusion, international experts from 30 countries typically defined ACP as person-centered conversations to choose future care and treatment, without focusing on end of life or documentation. Future research should evaluate the extent to which such conceptualization of ACP is present within clinical programs and practice recommendations and monitor changes over time.

Authors 8

1. Jenny Theodora van der Steen Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center , Leiden, Zuid-Holland, Netherlands

2. Emma J de Wit Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center , Leiden, Zuid-Holland, Netherlands

3. Mandy Visser
   Affiliation as printed

   Topaz , Leiden, Zuid-Holland, Netherlands

4. Miharu Nakanishi

   Tohoku University

   Affiliation as printed

   Tohoku University Graduate School of Medicine, Sendai-shi , Miyagi,

5. Lieve Van den Block

   Vrije Universiteit Brussel

   Affiliation as printed

   Vrije Universiteit Brussel (VUB), Brussels, Brussels Hoofdstedelijk Gewest ,

6. Ida J. Korfage

   Erasmus MC

   Affiliation as printed

   Erasmus MC, University Medical Center , Rotterdam, Zuid-Holland, Netherlands

7. Jürgen in der Schmitten

   University of Duisburg-Essen

   Affiliation as printed

   University of Duisburg-Essen , Essen, Nordrhein-Westfalen,

8. Rebecca L. Sudore

   University of California, San Francisco

   Affiliation as printed

   University of California San Francisco , San Francisco, California, United States