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Advance care planning

 

For medical teams it is often difficult to take patients’ wishes into consideration and to support patients’ family members. To gain insight into these processes, this study will bring together and test the instruments of advanced care planning and decision aids.

Project description (completed research project)

In the last 20 years, it has been shown that it is ethically and legally important to make patients’ living wills and advance directives more legally binding. The forthcoming new "adult protection law" will support this. However, this will not guarantee that treatments at the end of life will be adapted to the patients’ wishes or that decision-making will be easier for patients, their families and the medical team.

Aim

This study aims to work with national and international partners to develop best practice in planning for the end of life. For Switzerland this means first testing a programme for acute hospitals. As one part of the programme, physicians will receive further training in this area. For another, and similar to successful programmes in other countries, also other qualified health care staff (nurses, social workers, pastors) will be certified hold conversations and provide information. The programme will be tested by means of an intervention study. Participants will be competent patients that have a life expectancy of a few weeks or months and their closest relatives.

Relevance

Previous studies have shown that programmes with structured informational conversations by trained medical teams lead to an increase in the number of living wills and advance directives; decision uncertainty decreases, and patients’ wishes are followed more frequently. In addition, after the patient’s death, family members appear to be significantly less traumatised and depressed. With these programmes, there is also a drop in the number of invasive medical procedures and in the costs at the end of life, with no negative effect on mortality. The research team hopes that, by means of the further education programme and associated documentation as well as the sharing of information between hospital, rescue services and primary care physicians, practices can be significantly improved.

Original title

Multiprofessional advance care planning and shared decision making for end of life care MAPS Trial

Project leader

  • Dr. Tanja Krones, Klinische Ethik Universitätsspital, Universität Zürich
  • Prof. Nikola Biller-Andorno, Institut für Biomedizinische Ethik, Universität Zürich
  • Dr. Kathrin Zaugg, Klinik für Radio-Onkologie, Departement Medizinische Radiologie, Universitätsspital Zürich
  • Prof. Rebecca Spirig, Zentrum Klinische Pflegewissenschaft, Universitätsspital Zürich

Institutionelle Zusammenarbeit

  • Verschiedene Abteilungen des Universitätsspitals Zürich
  • Institut für Hausarztmedizin
  • Notfall/Rettung Zürich
  • Hospiz Zürcher Lighthouse
  • Institut Neumünster
  • Schweizer Rotes Kreuz
  • Harvard University
  • Programm "Beizeiten Begleiten"
  • Ottawa Health Research Institute
  • ACPEL Society

 

 

Further information on this content

 Contact

Dr. Tanja Krones Universität Zürich
Leitende Ärztin Klinische Ethik Universitätsspital
Gloriastrasse 3
DERM C 18
8091 Zürich +41 44 255 34 70 tanja.krones@usz.ch

Products of the project