Advance care planning

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.

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.

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.

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