[The Patient-Centered Emergency Plan - Practical Experiences]. / Der patientenzentrierte Notfallplan ­ Erfahrungen aus der Praxis.

The Patient-Centered Emergency Plan - Practical Experiences Abstract. Most people in Switzerland wish to die at home. This practical report shows how the cooperation of family physicians and a specialized palliative care team as well as the application of an emergency plan individually adapted to the general goal of care and the basic illness of the patient can support the realization of this wish. Good coordination of advance care planning through an individualized patient-centered emergency plan as well as the joint implementation of this care by the interdisciplinary, multiprofessional treatment team and the organization of a good care network are essential components to avoid unwanted emergency hospitalizations at the end of life.

Advance care planning for the severely ill in the hospital: a randomized trial.

OBJECTIVES: To investigate the impact of advance care planning (ACP) including decision aids for severely ill medical inpatients. METHODS: Single-centre randomised controlled trial at a Swiss university hospital. Patients were randomly assigned (1:1) to receive an extra consultation with the hospital social service or a consultation with in-house facilitators trained according to an internationally established ACP programme. Trial participants with the exception of the observers were fully blinded. 115 competent severely ill adults, their surrogates and their attending physicians were enrolled and followed for 6 months after discharge or 3 months after death. The patient's wishes regarding resuscitation (primary outcome), last place of care and other end-of-life wishes were recorded. Knowledge and respect of the patient's wishes by the surrogates and attending physician were monitored. RESULTS: Compared with controls, 6 months after the intervention, fewer patients wished to be resuscitated or were undecided (p=0.01), resuscitation wishes were documented more frequently (89% vs 64%, p=0.02) and surrogates and/or attending physicians had greater knowledge of the patient's wishes (62% vs 30%, p=0.01). Groups were not different with regard to wishes being fulfilled, with the exception of last place of care being achieved more frequently in the intervention group (29% vs 11 %, p=0.05). CONCLUSION: ACP including decision aids offered to severely ill medical inpatients leads to greater knowledge, documentation and respect of treatment and end-of-life wishes. Introducing ACP to these patients however may be too late for many patients. Early integration of ACP during the illness trajectory and a broader regional approach may be more appropriate.

[Advance Care Planning in Swiss Nursing Homes: Results of a Focus Group Study]. / Advance Care Planning in schweizerischen Alters- und Pflegeheimen: Ergebnisse einer Fokusgruppenstudie.

Advance Care Planning in Swiss Nursing Homes: Results of a Focus Group Study Abstract. Advance Care Planning (ACP) is a standardized consultation process in which patients define their therapy goals for future medical treatments with the help of a qualified health care facilitator. This way, ACP increases the probability that patients' wishes are fulfilled in case of decisional incapacity. The aim of this study was to implement a previously tested Swiss ACP program in two Swiss nursing homes to better understand the resulting processes, chances and difficulties. For this purpose focus group interviews were conducted after first implementation steps. The results show that an ACP implementation needs and must be coordinated with an approach covering the entire health system.