Eigene Wege gemeinsam gehen - Implementierung und Evaluation von Advance Care Planning in der ambulanten Pflege unter besonderer Berücksichtigung der Perspektive pflegender Angehöriger

Background
Advance Care Planning (ACP) is a process led by trained health professionals
aiming to ensure that people receive medical care in line with their wishes and
values even if they are unable to make decisions for themselves. This process is
particularly relevant for older care-dependent people, who in Germany are mainly cared for at home by relatives and home care services.

Aim
The overall aim of this dissertation is to explore which factors influence the
implementation of ACP, especially in the home care setting and from family
caregivers’ perspective.

Methods
With a systematic review with qualitative meta-synthesis caregivers’ experiences
with and their attitude towards ACP were summarised. Their perception of a nurse led ACP intervention was examined as part of the process evaluation of the
STADPLAN study.

Results
The meta-synthesis showed that ACP in each family constellation is unique, and
health professionals need to adapt the ACP process to the needs of all parties
involved. To achieve this goal, communicative skills and time resources of health
professionals are paramount.
In the STADPLAN study family caregivers showed a largely varying degree to
participate in ACP. An existing relationship of trust with the home care service and the expertise and communicative qualifications of the nurse were facilitators for ACP. Some participants rated other specialists as better suited for this topic.

Discussion
Both the literature-based and the empirical part of this work showed how important it is to tailor an ACP intervention to the individual needs of patients and their families. For this, expanded competencies of healthcare professionals offering ACP are required. These include medical expertise and knowledge of available health care services. A high level of communication skills is particularly important.

Conclusions
Prerequisites for the implementation of ACP are sufficient time resources and
qualification of health professionals. Research objectives are to evaluate the
implementation of ACP interventions integrating the individual perspectives of all parties involved.