Advance decision planning (ADP) in patients suffering from degenerative, advanced or terminal diseases is something that improves healthcare management in the final stage of the patient’s life. It is a procedure that would guarantee respect for patients’ autonomy when they lose the capacity to decide. In addition, it provides them with healthcare support, which is essential for the patient and his or her family at this stage, avoiding invasive treatments that cause more emotional discomfort.
Patients susceptible to receive Advance Decision Planning
There are patients classified as Patients with Complex Chronic Disease (PCC) and Patients with Advanced Chronic Disease (MACA). The former have a prevalence of 3.5 – 5% of the population and are characterized by pluripathology. Their evolution is dynamic and they require a high use of emergency services, consumption of health resources, drugs and health care. In contrast, patients with MACA account for 1.5% of the population, with a clinical profile similar to that of CCP, but who also suffer a more severe clinical condition, with a perception of a limited life prognosis.
What is Advance Decision Planning and what benefits does it provide?
ADP is a way of allowing these groups of patients with advanced diseases to express their wishes when they are in an irreversible process with a poor prognosis. However, there are cases in which it is difficult, due to the clinical or mental situation of the patient, since he/she cannot express his/her will and it is not documented in a medical record. This leaves their preferences uncertain and generates discomfort in the family.
When should Advance Decision Planning be done and why?
If you want to carry out a correct PDA, it is important to do it when the terminal illness is still in its early stages. It is important to note that when the patient is not able to express his or her will and complications arise, it will be the family who must participate in this decision making. This is sometimes a complication, because the family is not aware of it, and they play an important role in the patient’s end of life.
It is important for the geriatric specialist to achieve good communication with the patient. This will allow him/her to transmit adequate information about the disease and to take into account the patient’s values, so that he/she can also participate in the decision making process. To achieve this communication it is necessary for professionals to be trained in attitudes, knowledge and communication skills, always with the aim of adequately accompanying the patient and family, respecting their values and wishes in the last stage of life.