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Final report (German)

 

Contact

 Dr. jur. Sonja Rothärmel
Universität Augsburg
Institut für Bio- Gesundheits- und Medizinrecht
Universitätsstrasse 2, 86135 Augsburg
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Collaborative research project RESPECT – Respect for advance decisions and preferences in the case of illness and death. Controlled intervention study for the process- and system-oriented implementation of patients’ advance decisions in old people’s homes and the relevant care structures of a model region

Project leaders

 

Cooperations

 

Background

With the “law on advance patient decisions”, which came into force on 1st September 2009, the legislator confirmed the binding nature of patients’ advance decisions. However, international experiences show that this legal anchoring of patients’ advance decisions alone does not guarantee an effective safeguarding of self-determination at the end of life.

 

This situation can be fundamentally improved if one understands patients’ advance decisions as (only) one element in a more comprehensive communicative process of healthcare planning (Advance Care Planning, ACP). The project RESPECT, which is funded by the German Federal Ministry for Education and Research (BMBF), attempts to develop such a system of healthcare planning for institutions for the elderly of one model region and networked care structures and to scientifically evaluate it.

 

Implementation of “accompany in good time®” in a model region

With the newly developed intervention “accompany in good time®”, in an adaptation of the ACP program Respecting Choices ® (LaCrosse, USA) to German conditions, persons living in homes for the elderly (and/or their representatives) in a model region are supported in reflecting upon future critical decision situations and to form and articulate their wishes in terms of future treatments.

 

In the framework of the project, qualified employees in the homes for the elderly support the residents and where applicable their family members along with equally trained GPs in the development of their personal care planning. An integral component of patients’ advance decisions are separate GP instructions in the case of emergency (HAnNO), which precisely and succinctly document possible limitations of life-prolonging treatment measures for the case of an acute medical crisis.

 

At the same time, a multi-faceted intervention in the model region leads to these action-relevant patient advance decisions including the instructions for emergencies being seen and respected. In this respect, the employees of the homes for the elderly, the emergency services and the responsible hospital are informed about the system of care planning and prepared for the implementation of the advance treatment wishes.

 

Scientific evaluation of the systemic intervention

In the framework of a controlled inter-regional study, it is examined whether the rate of meaningful and valid advance decisions increases in the intervention region (with 4 homes for the elderly) compared to two control regions (with a total of 10 homes for the elderly) and whether clinical effects in accordance with the wishes of those affected can be represented.

 

In the case of positive validation, the program is suitable for broad application and can contribute, following the legal anchoring of patients’ advance decisions in Germany, to senior citizens living in institutions being regularly supported in the information regarding this complex instrument and its responsible use.

The project was extended to 30.11.11 in order, among other things, to enable a follow-up survey. First results of the statistical analysis are expected in May. In a conference of the North Rhine Medical Association on 21.06.2011 from 10am to 5pm, project results and a sustainable regional implementation of “accompany in good time®” will be put up for discussion by an expert public. The project will also be presented at the subsequent International Advance Care Planning Conference in London (22.-24.06.11).

 

Supporting institutions




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