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Medline ® Abstracts for References 16,17

of 'Advance care planning and advance directives'

Advance care planning for patients with COPD: past, present and future.
Janssen DJ, Engelberg RA, Wouters EF, Curtis JR
Patient Educ Couns. 2012 Jan;86(1):19-24. Epub 2011 Feb 12.
OBJECTIVE: To discuss the importance, current status and directions for improvement of advance care planning and communication about end-of-life care for patients with Chronic Obstructive Pulmonary Disease (COPD).
METHODS: Narrative review of the currently available literature regarding advance care planning and communication about end-of-life care in COPD.
RESULTS: Advance care planning, including patient-clinician communication about end-of-life care, can improve outcomes for patients and their families and may be particularly important for patients with COPD. Patient-clinician communication is needed to inform and prepare patients about their diagnosis, treatment, prognosis, and what dying might be like. It is necessary to help patients and their clinicians understand patient preferences for life-sustaining treatments. Despite these advantages, advance care planning and conversations about end-of-life care in current practice are limited and their quality is often poor.
CONCLUSION: Advance care planning can improve outcomes for patients and their relatives. Recent studies provide directions for how to facilitate advance care planning for patients with COPD.
PRACTICE IMPLICATIONS: Advance care planning ought to be part of care for patients with advanced COPD. Future studies should focus on interventions to facilitate advance care planning in patients with COPD with the goal of improving the quality of end-of-life care.
Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands. daisyjanssen@proteion.nl
Hope and advance care planning in patients with end stage renal disease: qualitative interview study.
Davison SN, Simpson C
BMJ. 2006 Oct;333(7574):886. Epub 2006 Sep 21.
OBJECTIVE: To understand hope in the context of advance care planning from the perspective of patients with end stage renal disease.
DESIGN: Qualitative in-depth interview study.
SETTING: Outpatient department of a university affiliated nephrology programme.
PARTICIPANTS: 19 patients with end stage renal disease purposively selected from the renal insufficiency, haemodialysis, and peritoneal dialysis clinics.
RESULTS: Patients' hopes were highly individualised and were shaped by personal values. They reflected a preoccupation with their daily lives. Participants identified hope as central to the process of advance care planning in that hope helped them to determine future goals of care and provided insight into the perceived benefits of advance care planning and their willingness to engage in end of life discussions. More information earlier in the course of the illness focusing on the impact on daily life, along with empowerment of the patient and enhancing professional and personal relationships, were key factors in sustaining patients' ability to hope. This helped them to imagine possibilities for a future that were consistent with their values and hopes. The reliance on health professionals to initiate end of life discussions and the daily focus of clinical care were seen as potential barriers to hope.
CONCLUSIONS: Facilitated advance care planning through the provision of timely appropriate information can positively enhance rather than diminish patients' hope. Current practices concerning disclosure of prognosis are ethically and psychologically inadequate in that they do not meet the needs of patients.
Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada. sara.davison@ualberta.ca