title: Implementing an advance care planning program in German nursing homes: results of an inter-regionally controlled intervention trial.
abstract: BACKGROUND
  Advance Care Planning (ACP) is a systematic approach to ensure that effective advance directives (ADs) are developed and respected. We studied the effects of implementing a regional ACP program in Germany.
  
  
  METHODS
  In a prospective, inter-regionally controlled trial focusing on nursing homes (n/hs), we compared the number, relevance and validity of new ADs completed in the intervention region versus the control region. Intervention n/h residents and their families were offered professional facilitation including standardized documentation.
  
  
  RESULTS
  Data from 136 residents of three intervention n/hs were compared with data from 439 residents of 10 control n/hs over a study period of 16.5 months. In the intervention region, 49 (36.0%) participating residents completed a new AD over the period of the study, compared to 18 (4.1%) in the control region; these ADs included 30 ADs by proxy in the intervention region versus 10 in the control region. Proxies were designated in 94.7% versus 50.0% of cases, the AD was signed by a physician in 93.9% versus 16.7%, and an emergency order was included in 98.0% versus 44.4%. Resuscitation status was addressed in 95.9% versus 38.9% of cases (p<0.01 for all of the differences mentioned above). In the intervention region, new ADs were preceded by an average of 2.5 facilitated conversations (range, 2–5) with a mean total duration of 100 minutes (range, 60–240 minutes).
  
  
  CONCLUSIONS
  The implementation of an ACP program in German nursing homes led, much more frequently than previously reported, to the creation of advance directives with potential relevance to medical decision-making. Future research should assess the effect of such programs on clinical and structural outcomes.
authors.affiliation: Department of General Practice, Düsseldorf University, University Hospital, Institute for Patient Safety, Rheinische Friedrich-Wilhelms-Universität Bonn, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Institute of Ethics, History and Theory of Medicine at the Ludwig Maximilians University Munich.
authors.forename: Jürgen
authors.initials: J
authors.lastname: In der Schmitten
authors.forename: Katharina
authors.initials: K
authors.lastname: Lex
authors.forename: Christine
authors.initials: C
authors.lastname: Mellert
authors.forename: Sonja
authors.initials: S
authors.lastname: Rothärmel
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Georg
authors.initials: G
authors.lastname: Marckmann
mesh_terms: D032722:Advance Care Planning / Q000458:organization & administration*; D024362:Advance Directive Adherence / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D006293:Health Promotion / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009732:Nursing Care / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000458:organization & administration* / Q000706:statistics & numerical data; D010347:Patient Care Planning / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D012040:Regional Health Planning / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000706:statistics & numerical data