Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care

Advance care planning (ACP) is increasingly implemented in oncology and beyond, but a definition of ACP and recommendations concerning its use are lacking. We used a formal Delphi consensus process to help develop a definition of ACP and provide recommendations for its application. Of the 109 expert...

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Bibliographic Details
Published in:The lancet oncology 2017-09, Vol.18 (9), p.e543-e551
Main Authors: Rietjens, Judith A C, Sudore, Rebecca L, Connolly, Michael, van Delden, Johannes J, Drickamer, Margaret A, Droger, Mirjam, van der Heide, Agnes, Heyland, Daren K, Houttekier, Dirk, Janssen, Daisy J A, Orsi, Luciano, Payne, Sheila, Seymour, Jane, Jox, Ralf J, Korfage, Ida J
Format: Article
Language:English
Subjects:
Advance Care Planning
Advance directives
Attitude of Health Personnel
Clinical medicine
Consensus
Delphi Technique
Experts
Feasibility studies
Health care
Humans
Interdisciplinary aspects
Oncology
Palliative Care
Patient satisfaction
Planning
Researchers
Working groups
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Summary:Advance care planning (ACP) is increasingly implemented in oncology and beyond, but a definition of ACP and recommendations concerning its use are lacking. We used a formal Delphi consensus process to help develop a definition of ACP and provide recommendations for its application. Of the 109 experts (82 from Europe, 16 from North America, and 11 from Australia) who rated the ACP definitions and its 41 recommendations, agreement for each definition or recommendation was between 68–100%. ACP was defined as the ability to enable individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and health-care providers, and to record and review these preferences if appropriate. Recommendations included the adaptation of ACP based on the readiness of the individual; targeting ACP content as the individual's health condition worsens; and, using trained non-physician facilitators to support the ACP process. We present a list of outcome measures to enable the pooling and comparison of results of ACP studies. We believe that our recommendations can provide guidance for clinical practice, ACP policy, and research.
ISSN:1470-2045
1474-5488
DOI:10.1016/S1470-2045(17)30582-X