[Experiences of Austrian nursing staff in dealing with advance directives]. / Umgang von österreichischen Pflegepersonen mit der Patientenverfügung.

BACKGROUND: Advance directive is a contemporary issue because of accentuation of patients' autonomy and the increasing medical progress. But problems arise in drafting an advance directive as well as in realisation of advance directives in institutions. The duties and the influence of nursing in this context are hardly an object of scientific investigations. This article first describes empirically the role of nurses in connection with advance directives. AIM: AIM of this study is the description of nurses' experiences in connection with advance directives. METHOD: A descriptive-explorative cross-section design was used for this study. Data were recorded by means of a semi-structured questionnaire. This questionnaire was handed out to 266 nurses working at an Austrian university hospital. RESULTS: On the part of nurses there is a great insecurity with concurrent existence of sufficient theoretical professional knowledge and missing structures of the part of organisation. Because of these situations some interdisciplinary conflicts arise in connection with realisation of advanced directives. CONCLUSION: To avoid conflicts and to improve the handling and realisation of advance directives in practice it is recommendable to establish clinical ethical consultation. The tasks of the clinical ethical consultation are the creation and implementation of ethical directives in the institution, the realisation of individual case discussions and the ethical education of the affected health care professionals.

To tatou reo - Our voice: Advance Care Planning in Aotearoa New Zealand.

The advance care planning programme in Aotearoa New Zealand aims to empower all New Zealanders to participate in planning their future health and end-of-life care. Guided by the core values of our 2022-25 strategy, the programme has developed education, tools and resources to support consumers, their family and whanau and clinicians to optimise the opportunities for what matters most to a person to guide and inform care delivery throughout their life.

Advance Care Planning in Brazil.

Brazil is a country of continental size marked by extreme social inequalities. Its regulation of Advance Directives (AD) was not enacted by law but within the scope of the norms that govern the relationships between patients and physicians, as a resolution of the Federal Medical Council without any specific requirement for notarization. Despite this innovative starting point, most of the debate regarding Advance Care Planning (ACP) in Brazil has been dominated by a legal transactional approach focused on making decisions in advance and the creation of AD. Yet, other novel ACP models have recently emerged in the country with a focus on the creation of a specific quality of relationship between patients, families, and physicians aiming at the facilitating future decision-making. Most of the education on ACP in Brazil happens in the context of palliative care courses. As such, most ACP conversations are performed within palliative care services or by healthcare professionals with training in that area. Hence, the scarce access to palliative care services in the country means that ACP is still rare and that those conversations usually happen late in the course of disease. The authors posit that the existing paternalistic healthcare culture is one of the most important barriers to ACP in Brazil and envision with great concern the risk that its combination with extreme health inequalities and the lack of healthcare professionals' education on shared decision-making could lead to the misuse of ACP as a form of coercive practice to reduce healthcare use by vulnerable populations.

Advance Care Planning in Belgium.

This paper aims to 1) describe current levels of Advance Care Planning (ACP) development since 2002 in Belgium, 2) report on challenges and opportunities to inspire other countries with similar contextual characteristics and 3) support further development of ACP practice and research in Belgium. To address these aims, we consulted local researchers, 12 domain experts and (grey) literature (regulatory documents, reports, policy documents and practice guidelines) on ACP, palliative care, and related healthcare topics. Since 2002, when the Patient's Right Law was passed in the federal Parliament, Belgium has had a specific medicolegal context for ACP. Initiatives to improve the uptake of ACP have been taken, e.g. standardised documentation, reimbursement codes for physicians provided by the government, and implementation of quality indicators in hospitals and nursing homes. Most of these initiatives are grassroots or predominantly oriented towards a single group of professions, e.g. general practitioners, disregarding the role that other professions can play. The patient groups most often targeted are those with cancer and older adults. Limited but growing attention is given to those with low health literacy or other minority groups. Main barriers to ACP in Belgium are: no unified platform to exchange outcomes of ACP discussions or advance directives between healthcare professionals and though efforts are made, ACP is still predominantly oriented towards documentation.

Advance Care Planning in India: Current status and future directions. A short narrative review.

India is undergoing economic, demographic and epidemiologic transitions. The healthcare industry is expanding rapidly as the burden of non-communicable diseases increases. The Indian Supreme Court [1] has recently enabled Advance Medical Directives (AMD). Implementation of Advance Care Planning (ACP) will depend on civil society and the palliative care sector until government support is available.

Advance Care Planning in Malaysia.

BACKGROUND: In Malaysia, advance care planning is still in its infancy. There is no national implementation of Advance Care Planning. AIMS: To describe the national state of advance care planning development in Malaysia METHODS: Review of relevant advance care planning literature locally and internationally was undertaken. RESULTS: Positive development in Malaysia includes implementation of advance care planning at institutional level, initiatives to develop educational programmes as well as research activities to understand the attitude and perception of patients on advance care planning. However, there remain challenges, including lack of knowledge and awareness, lack of legislative framework to guide advance care planning implementation and lack of strong initiatives at a national level. CONCLUSIONS: It is evident that there is much to learn nationally and internationally about ACP before any decision on implementation of ACP is made in Malaysia. ACP is a public health issue and requires concerted effort of all stakeholders, including Government agencies, academic institutions, and non-government organizations to raise public awareness. More research is needed to shape the future direction of ACP development in Malaysia.

How should Argentina raise Advance Care Planning awareness? Introduction of the Shared Care Planning Group.

The WHO Concept Model of Palliative Care emphasises empowering people and communities with Advance Care Planning (ACP). In Latin America, a more relational approach involving family members is suited to ACP. Improvements in doctor-patient-family relationships are needed. Policy efforts have been made to foster ACP in Argentina's healthcare system, but implementation barriers include a need for more communication skills and coordination between healthcare providers. The Shared Care Planning Group Argentina aims to promote ACP through research and training programs. It has sensitised and trained 236 healthcare providers in short courses to introduce basic information and skills. However, there needs to be specific documentation for ACP in Argentina. Research found obstacles to ACP implementation, such as the inability to converse with patients and the lack of coordination between healthcare teams. A new project will assess the self-efficacy of healthcare professionals who assist patients with Sclerosis Lateral Amyotrophic in ACP and evaluate a specific training program. Patient and public involvement in ACP remains limited in Argentina, with paternalistic medical culture and a need for more awareness and training among healthcare professionals as significant barriers. Collaborative research projects with Spain and Ecuador aim to train healthcare professionals and evaluate ACP implementation in other Latin American countries.

Practices to overcome the inexistence of Advance Care Planning in Poland.

Although the first Advance Care Planning (ACP) models were developed decades ago, Poland is still a country where ACP has not yet been implemented, despite its apparent benefits for both patients and the health care system. This article presents the legal and cultural context, main impediments, and opportunities for implementing ACP in Poland. Legal regulations are mandatory to ensure respect for the patient's will. Raising public awareness seems to be a cornerstone of the shift of paradigm. We strongly believe that the support of experienced countries is indispensable.

Advance Care Planning in Germany.

Advance Care Planning (ACP) defined as a comprehensive concept requiring a cultural change following implementation at the individual, institutional and regional level in order to achieve care consistency with care preferences when individuals are incapable of participating in critical decisions was first implemented in two regional projects (LIMITS and beizeiten begleiten, North Rhine Westphalia) in Germany in the 2000s. Based on the positive evaluation of beizeiten begleiten, legislation of 2015 (§ 132g, Social Code Book V) allows nursing homes and care homes for persons with disabilities to offer qualified ACP facilitation covered by the statutory health insurance. However, trainers for ACP facilitators need no specific qualification, and the training program for ACP facilitators is only broadly defined, which resulted in great heterogeneity of ACP facilitator qualifications. Furthermore, neither the institutional nor the regional implementation are sufficiently considered in this legislation, i.e. essential components of a successful implementation of ACP are missing. Nevertheless, a growing number of initiatives, research projects and a professional national society for ACP, engage in approaches to advance institutional and regional implementation, and to offer ACP to other target groups beyond the legal framework.

[Prise en compte du contexte culturel en tant que partie intégrante des «soins spirituels¼]. / Berücksichtigung des kulturellen Hintergrunds als Teil der «Spiritual Care¼.

Consideration of the Cultural Background as Part of "Spiritual Care" Abstract. Living wills take up central points of End of Life Decisions in terms of content. Ethical principles that enable us to approach such issues are embedded in a cultural context. The latter plays an increasingly central role in patient-centered medicine. Using the example of Jewish Orthodox legislation (Halacha), we will show how the cultural background can be considered when creating a living will. Using so-called "emic" (culturally immanent) and "etic" (culturally comparative) content-analytical approaches, this will then be compared with the guidelines of the Swiss Academy of Medical Sciences (SAMS). The latter partly provide guidelines for certain questions which are left completely open by the Halacha, but also vice versa. Despite these different weightings, similar positions often result in practice.

[CME: Self-Determined Dying: The Challenge of Medical End-of-Life Decisions]. / CME: Selbstbestimmung am Lebensende: die Herausforderung medizinischer End-of-Life-Entscheidungen CME-Fragen.

CME: Self-Determined Dying: The Challenge of Medical End-of-Life Decisions Abstract. Modern medical interventions make it possible today to postpone dying. Thus the process of dying confronts with numerous end-of-life decisions. The authority to make such decisions does not lie with the doctors. It is the unique right of the autonomous patient. This right can be experienced as freedom of choice, but also as an excessive demand. Doctors are responsible for supporting their patients in such a way that they become able to make relevant decisions concerning their dying process. In this context modern instruments such as advance directives or advance care planning play an important role. When patients are no longer able to decide for themselves, legal regulations define who is authorised to decide in their place.

[CME/Answers: Self-Determined Dying: The Challenge of Medical End-of-Life Decisions]. / CME/Antworten: Selbstbestimmung am Lebensende: die Herausforderung medizinischer End-of-Life-Entscheidungen.

CME/Answers: Self-Determined Dying: The Challenge of Medical End-of-Life Decisions Abstract. Modern medical interventions make it possible today to postpone dying. Thus the process of dying confronts with numerous end-of-life decisions. The authority to make such decisions does not lie with the doctors. It is the unique right of the autonomous patient. This right can be experienced as freedom of choice, but also as an excessive demand. Doctors are responsible for supporting their patients in such a way that they become able to make relevant decisions concerning their dying process. In this context modern instruments such as advance directives or advance care planning play an important role. When patients are no longer able to decide for themselves, legal regulations define who is authorised to decide in their place.

[So That My Will May Be Done - Implementation of the Patient's Will by Means of Advance Care Planning]. / Damit mein Wille auch geschehe ­ Umsetzung des Patientenwillens mittels Advance Care Planning.

So That My Will May Be Done - Implementation of the Patient's Will by Means of Advance Care Planning Abstract. The current developments regarding ACP in Switzerland are an important step towards overcoming the existing deficits and weaknesses of 'traditional' living wills. As global research has shown, the wishes and treatment preferences of patients who, due to their inability to judge, are no longer able to express themselves about medical treatment options, can actually be respected and implemented in this way.

[Resuscitation Decision in Geriatric Patients: Different Views and Possible Decision-Making Aids]. / Reanimationsentscheidung bei geriatrischen Patienten: Verschiedene Ansichten und mögliche Entscheidungshilfen.

Resuscitation Decision in Geriatric Patients: Different Views and Possible Decision-Making Aids Abstract. The decision to resuscitate in hospitalized elderly multimorbid patients can be difficult and challenging, since there are no generally accepted guidelines or reliable medical parameters. This study illustrates that relevant differences exist between physicians and caregivers in the decision to resuscitate. From the point of view of physicans, caregivers and relatives resuscitation should be avoided in cases of severely restricted cognition, mobility and independence. Only 8 % of the patients have a living will and 17 % can no longer make a decision at the end of life. ACP is an important tool in the care of multimorbid geriatric patients and their relatives and can optimize the decision to resuscitate as well as the mode of dying.

[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.