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It is important to talk about approaching end of life

Terminally ill people benefit from timely discussions about their wishes for future care and treatment. In this way they can avoid getting treatment that they would rather not have had.

Advanced Care Planning 
Advance decision
Researchers Judith Rietjens and Ida Korhage of Erasmus MC's department  of Public Health have published an article on this topic in the leading journal The Lancet Oncology.

Advance care planning (ACP) is a process in which patients discuss their goals and preferences for future care and treatment with their family and the attending physician. These preferences can be set out in an advance decision (also known as living will), prior to patients being unable to make or communicate those decisions themselves.
ACP is important because patients are sometimes given care and treatment that they would have preferred not to have had, such as resuscitation or acute hospitalization in the final phase of life. These decisions are often made in situations in which the patient is unable to make decisions or in which decisions need to be made very quickly.

Thinking about what the patient wants in such circumstances and timely discussions on this with family and healthcare providers will increase the chances of the wishes and preferences of the patient being included in the  decision making. ACP also makes it easier for family to make good decisions together with the care providers when the patient is no longer able to do this.

Recommendations
There is still a lot of confusion about what ACP is and how ACP should be implemented in practice.  Is ACP suitable for all patients? What should be discussed? When should this be discussed? And who is actually responsible for ACP?
Rietjens, Korfage and other researchers made recommendations based on the knowledge and views of more than a hundred experts, from 14 countries, in the field of ACP. 

One of the recommendations, for example, is that discussions on future care and treatment should be the tailored to the patient's degree of willingness to think about it. Moreover, the researchers established that ACP is a dynamic process rather than it representing a snapshot. Discussions can be started as soon as the patient wishes to, even early on in the disease process.

It is also important that the talks and advance decision are reviewed when the patient's health deteriorates, and that the patient shares this with family and care provider. After all, the wishes for care and treatment can change or become more specific. The study was conducted on behalf of the European Association for Palliative Care (EAPC).

Date published: 4 September 2017.

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