Advance Care Planning for palliative care patients – the ACP-NOPA web application
B. Loupatatzis1, I. Karzig-Roduner2, M. Obrist2, T. Otto2, A. Weber1, T. Krones2 (1Wetzikon ; 2Zürich)
Over the last two decades Advance Care Planning (ACP) has been developed as a structured complex intervention to help patients formulating their wishes for future care and planning for crisis. It has been proven an effective tool that patients’ wishes are better known, better documented and more often respected in case of emergency. However, in palliative care many patients wish for a peaceful death at home and ACP alone is not enough to help these patients to stay at home till the end. On the other hand, it is well known in literature and in daily palliative care practice that the use of “emergency plans” in which palliative care workers talk to patients and their relatives about emergencies which are likely to occur and enable them to provide the means to perform adequate symptom control at home help to avoid burdensome transitions in the last weeks or days of life.
To implement a system combining ACP and palliative emergency planning, accessible for all health professionals chosen by the patient, providing the measures for palliative care patients to stay in the place of their choice until death.
Based on our experiences with the MAPS–trial (a randomized controlled trail about ACP in the NFP67 project performed 2012-2017), we developed a web-based application to support professional care givers in conducting an ACP conversation based on international standards as well as in generating an emergency plan for the most common palliative emergency scenarios based on the patient’s illness. We performed and evaluated an educational program for these facilitators. We are now performing a feasibility study with piloting teams in different in- and out-settings in the Kanton of Zurich.
We will present our concept, the results of the evaluation of the educational program and the preliminary results of the ongoing feasibility study.
Finding out the wishes and therapeutic goals of patients is a core competence in ACP. Anticipating common emergency situations and planning for them is a core competence of palliative care. Combining both strategies in a webbased application to support professional care givers in making highly individualized palliative emergency plans based on patients wishes seems to be a good way to help terminally ill patients to stay at their favourite last-place-of care.