title: Advance Care Planning in terminally ill and frail older persons.
abstract: OBJECTIVE
  Advance Care Planning (ACP) - the communication process by which patients establish goals and preferences for future care - is encouraged to improve the quality of end-of-life care. Gaining insight into the views of elderly on ACP was the aim of this study, as most studies concern younger patients.
  
  
  METHODS
  We conducted and analysed 38 semi-structured interviews in elderly patients with limited prognosis.
  
  
  RESULTS
  The majority of participants were willing to talk about dying. In some elderly, however, non-acceptance of their nearing death made ACP conversations impossible. Most of the participants wanted to plan those issues of end-of-life care related to personal experiences and fears. They were less interested in planning other end-of-life situations being outside of their power of imagination. Other factors determining if patients proceed to ACP were trust in family and/or physician and the need for control.
  
  
  CONCLUSIONS
  ACP is considered important by most elderly. However, there is a risk of pseudo-participation in case of non-acceptance of the nearing death or planning end-of-life situations outside the patient's power of imagination. This may result in end-of-life decisions not reflecting the patient's true wishes.
  
  
  CONCLUSIONS
  Before engaging in ACP conversations, physicians should explore if the patient accepts dying as a likely outcome. Also the experiences and fears concerning death and dying, trust and the need for control should be assessed.
authors.affiliation: Department of Geriatrics, Ghent University Hospital, Ghent, Belgium. ruth.piers@ugent.be
authors.forename: Ruth D
authors.initials: RD
authors.lastname: Piers
authors.forename: Ineke J
authors.initials: IJ
authors.lastname: van Eechoud
authors.forename: Sigrid
authors.initials: S
authors.lastname: Van Camp
authors.forename: Mieke
authors.initials: M
authors.lastname: Grypdonck
authors.forename: Myriam
authors.initials: M
authors.lastname: Deveugele
authors.forename: Natacha C
authors.initials: NC
authors.lastname: Verbeke
authors.forename: Nele J
authors.initials: NJ
authors.lastname: Van Den Noortgate
mesh_terms: D032722:Advance Care Planning / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D016330:Frail Elderly / Q000523:psychology* / Q000706:statistics & numerical data*; D006299:Health Services for the Aged; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D011788:Quality of Life; D019452:Terminally Ill / Q000523:psychology / Q000706:statistics & numerical data