title: The Palliative Treatment Plan as a Bone of Contention between Attending Physicians and Nurses.
abstract: Acute vital crisis in end-of-life situations may result in hospitalization and intensive care without recognizable benefit in many cases. Advance directives regarding indications for resuscitation, hospitalization, and symptomatic treatment help ensure that acute complications can be managed quickly and satisfactorily in the patient's customary surroundings. A plan was designed and implemented in Austrian nursing homes to provide emergency physicians with rapidly obtainable information on the patient's current situation, and whether resuscitation attempts and hospitalization are advised or not. This palliative treatment plan is arranged by a physician together with caregivers, close relatives, and the patient or his court-appointed health care guardian or holder of power of attorney. Four years after implementation of the plan, a user satisfaction survey was carried out. The majority of participating nurses, emergency physicians and family doctors judged application and design of the palliative treatment plan positively. However, the low response rate of family doctors indicates nonconformity. In particular, the delegation of symptomatic treatment to nurses proved to be controversial. There is still a need to provide up-to-date information and training for health professionals in order for them to understand advance directives as extended autonomy for patients who have lost their ability to make their own decisions.
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck A-6020, Austria. wolfgang.lederer@i-med.ac.at.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lederer
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck A-6020, Austria. Stefanie.graube@student.i-med.ac.at.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Graube
authors.affiliation: Institute for Palliative Care and Organisational Ethics, Faculty of Interdisciplinary Studies, IFF Vienna Campus and Alpen-Adria University, A-1070 Vienna and Paracelsus Medical University, Salzburg A-5020, Austria. angelika.feichtner@gmx.net.
authors.forename: Angelika
authors.initials: A
authors.lastname: Feichtner
authors.affiliation: Hospice and Palliative Care, Tyrolean Hospiz-Betriebsges.M.B.H., Innsbruck A-6020, Austria. elisabeth.medicus@hospiz-tirol.at.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Medicus
keywords: advance care planning; emergency medicine; geriatric medicine; nursing home; palliative care