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Development and implementation of an advance care planning program in Catalonia, Spain

Published online by Cambridge University Press:  05 October 2018

Cristina Lasmarías
Affiliation:
The Qualy Observatory-World Health Organization Collaborating Center for Public Health Palliative Care Programs (WHOCC-ICO), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain Chair of Palliative Care, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain Catalonia Chronic Care Research Group, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain
Amor Aradilla-Herrero
Affiliation:
Escuela Universitaria de Enfermería Gimbernat, Autonomous University of Barcelona, Sant Cugat del Vallès, Barcelona, Spain
Sebastià Santaeugènia
Affiliation:
Catalonia Chronic Care Research Group, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain National Strategy of Integrated and Chronic Care, Ministry of Health, Government of Catalonia, Barcelona, Spain
Carles Blay
Affiliation:
Catalonia Chronic Care Research Group, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain Medicine, University of Vic - Central University of Catalonia, Vic, Barcelona, Spain
Sara Delgado
Affiliation:
St Luke's Hospice, London, United Kingdom
Sara Ela
Affiliation:
The Qualy Observatory-World Health Organization Collaborating Center for Public Health Palliative Care Programs (WHOCC-ICO), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain Chair of Palliative Care, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain
Núria Terribas
Affiliation:
Chair of Bioethics, University of Vic-Central University of Catalonia, Fundació Grifols, Barcelona, Spain
Xavier Gómez-Batiste*
Affiliation:
The Qualy Observatory-World Health Organization Collaborating Center for Public Health Palliative Care Programs (WHOCC-ICO), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain Chair of Palliative Care, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain Catalonia Chronic Care Research Group, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain
*
Author for Correspondence: Xavier Gómez- Batiste Alentorn, MD, PhD, The Qualy Observatory-WHO Collaborating Center for Public Health Palliative Care Programs (WHOCC-ICO), Catalan Institute of Oncology, Avinguda Gran Via de L'Hospitalet, 199-203 08908 L'Hospitalet de Llobregat, Barcelona, Spain. E-mail: xgomez.whocc@iconcologia.net

Abstract

Objective

Implementation of an advance care planning (ACP) program for people with advanced chronic conditions is a complex process. The aims of this paper are to describe (1) the development of the ACP program in Catalonia, Spain, for patients with advanced chronic conditions and complex needs and (2) the preliminary results of the implementation of this program in health and social services.

Method

The ACP program was developed and implemented in a four-stage process as follows: (1) design and organization of the project; (2) selection of the professionals to carry out the project; (3) creation of four working groups to develop the conceptual model, guidelines, training program, and perform a qualitative evaluation; and (4) project implementation.

Result

The following deliverables were completed: (1) conceptual framework document; (2) practical guidelines for the application of the ACP; (3) online training course (3,763 healthcare professionals completed the online course, with an overall satisfaction rating of 8.4 on a 10-point scale); and (4) additional training activities (conferences, short courses, and seminars) in between 2015 and 2017.

Significance of results

This project was led by the Catalan Ministry of Health. The strengths of the project development include the contribution of a wide range of professionals from the entire region, approval by the Catalan Bioethics Committee and the Social Services Ethics Committee, and the ongoing validation by members of the community. A standardized online training course was offered to all primary care professionals and included as a quality indicator for continuing education for those professionals in the period 2016–2020. The main outcome of this project is the establishment of a pragmatic ACP throughout the region and training of the health and social care professionals involved in the care of advanced chronic patients.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2018 

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References

Abad-Corpa, E, García-Palomares, A, Martínez-Rodríguez, S, et al. (2006) Exploration of the phenomenon of advanced care decisions. The perspective of professionals caring for the elderly. Enfermeria Clinica 16, 127136. In Spanish.CrossRefGoogle Scholar
Altisent, R and Judez, J (2016) The challenge of advance care planning at the end of life in Spain. Medicina Paliativa 23, 163164. In Spanish.CrossRefGoogle Scholar
Amblàs-Novellas, J, Espaulella, J, Rexach, L, et al. (2015) Frailty, severity, progression and shared decision-making: A pragmatic framework for the challenge of clinical complexity at the end of life. European Geriatric Medicine 6, 189194.CrossRefGoogle Scholar
Baron, K, Hodgson, A and Walshe, C (2015) Evaluation of an advance care planning education programme for nursing homes: A longitudinal study. Nurse Education Today 35, 689695.CrossRefGoogle ScholarPubMed
Baughman, KR, Ludwick, R, Palmisano, B, et al. (2015) The relationship between organizational characteristics and advance care planning practices. American Journal of Hospice and Palliative Medicine 32, 510515.CrossRefGoogle ScholarPubMed
Biondo, PD, Lee, LD, Davison, SN, et al. (2016) Advance Care Planning Collaborative Research and Innovation Opportunities Program (ACP CRIO). How healthcare systems evaluate their advance care planning initiatives: Results from a systematic review. Palliative Medicine 30, 720729.CrossRefGoogle ScholarPubMed
Blay, C, Limón, E and Meléndez, A (2017) Chronic care, professionalism and the palliative care crossroads. Medicina Paliativa 24, 13. In Spanish.CrossRefGoogle Scholar
Busquets i Font, JM, Hidoine de La Fuente, M, Lushchenkova, O, et al. (2014) [Knowledge and assessment of advance directives and end-of-life care by the public in Catalonia.] Medicina Paliativa 21, 153159. In Spanish.CrossRefGoogle Scholar
Carrero Planes, V, Navarro Sanz, R and Serrano Font, M (2016) Advance care planning in patients with chronic disease and in need of palliative care. Medicina Paliativa 23, 3241. In Spanish.CrossRefGoogle Scholar
Catalan Ministry of Health, General Management of Health Planning (2016) [Catalan Health Plan 2016–2020. A person-centered system: public, universal and fair.] In Catalan. Available at: http://salutweb.gencat.cat/web/.content/home/el_departament/pla_de_salut/documents_pla_salut/doc_complexitat_final.pdf.Google Scholar
De Vleminck, A, Houttekier, D, Deliens, L, et al. (2016) Development of a complex intervention to support the initiation of advance care planning by general practitioners in patients at risk of deteriorating or dying: a phase 0–1 study. BMC Palliative Care 15, 17.CrossRefGoogle ScholarPubMed
Detering, K, Silvester, W, Corke, C, et al. (2014) Teaching general practitioners and doctors-in-training to discuss advance care planning: Evaluation of a brief multimodality education programme. BMJ Supportive & Palliative 4, 313321.CrossRefGoogle ScholarPubMed
Duckworth, S and Thompson, A (2017) Evaluation of the Advance Care Planning Programme. The Health Quality & Safety Commission and Health Workforce New Zealand: Litmus. Available at: https://www.hqsc.govt.nz/assets/ACP/PR/ACP_final_evaluation_report_290317.pdf.Google Scholar
Emanue, LL, von Gunten, CF and Ferris, FD (2000) Advance care planning. Archives of Family Medicine 9, 11811187.CrossRefGoogle Scholar
Flo, E, Husebo, BS, Bruusgaard, P, et al. (2016) A review of the implementation and research strategies of advance care planning in nursing homes. BMC Geriatrics 16, 24.CrossRefGoogle ScholarPubMed
Fried, J, Bullock, K, Iannone, L, et al. (2009) Understanding advance care planning as a process of health behavior change. Journal of the American Geriatrics Society 57, 15471555.CrossRefGoogle ScholarPubMed
Gilissen, J, Pivodic, L, Smets, T, et al. (2017) Preconditions for successful advance care planning in nursing homes: A systematic review. International Journal of Nursing Studies 66, 4759.CrossRefGoogle ScholarPubMed
Gómez-Batiste, X, Martínez-Muñoz, M., Blay, C, et al. (2013) Identifying chronic patients in need of palliative care in the general population: development of the NECPAL tool and preliminary prevalence rates in Catalonia. BMJ Supportive and Palliative Care 3, 300308.CrossRefGoogle ScholarPubMed
Gómez-Batiste, X, Martínez-Muñoz, M, Blay, C, et al. (2014) Prevalence and characteristics of patients with advanced chronic conditions in need of palliative care in the general population: A cross-sectional study. Palliative Medicine 28, 302311.CrossRefGoogle ScholarPubMed
Gómez-Batiste, X, Blay, C, Martínez-Muño, M, et al. (2016) The Catalonia WHO Demonstration Project of Palliative Care: Results at 25 years (1990–2015). Journal of Pain and Symptom Management 52, 9298.CrossRefGoogle Scholar
Gómez-Batiste, X, Murray, SA, Keri, T, et al. (2017) Comprehensive and integrated palliative care for people with advanced chronic conditions: An update from several European initiatives and recommendations for policy. Journal of Pain and Symptom Management 53, 509517.CrossRefGoogle ScholarPubMed
Granero-Moya, N, Frías-Osuna, A, Barrio-Cantalejo, IM, et al. (2016) Primary care nurses difficulties to implement APC processes: A qualitative study. Atención Primaria 48, 649656. In Spanish.CrossRefGoogle Scholar
Ham, C (2010) The ten characteristics of the high-performing chronic care system. Health Economics, Policy and Law 5, 7190.CrossRefGoogle ScholarPubMed
Hammes, BJ and Rooney, BL (1998) Death and end-of-life planning in one midwestern community. Archives of Internal Medicine 158, 383390.CrossRefGoogle ScholarPubMed
In der Schmitten, J, Rothärmel, S, Mellert, C, et al. (2011) A complex regional intervention to implement advance care planning in one town's nursing homes: Protocol of a controlled inter-regional study. BMC Health Services Research 11, 14.CrossRefGoogle ScholarPubMed
Ledesma, A, Blay, C, Contel, JC, et al. (2015) Catalan model of integrated care. Towards person-centered care. Barcelona: Pla interdepartamental d'atenció i interacció social i sanitària. In Catalan. Available at: http://presidencia.gencat.cat/web/.content/departament/plans_sectorials_i_interdepartamentals/PIAISS/docs/PIAISS_model_atencio_integrada_social_i_sanitaria.pdf.Google Scholar
MacKenzie, MA, Smith-Howell, E, Bomba, PA, et al. (2018) Respecting choices and related models of advance care planning: A systematic review of published evidence. American Journal of Hospice & Palliative Medicine 35, 897907.CrossRefGoogle ScholarPubMed
Mullick, A, Martin, J and Sallnow, L (2013) An introduction to advance care planning in practice. British Medical Journal 347, f6064.CrossRefGoogle ScholarPubMed
Overbeek, A, Korfage, IJ, Jabbarian, L, et al. (2018) Advance care planning in frail older adults: A cluster randomized controlled trial. Journal of the American Geriatrics Society 2018 [Epub ahead of print].Google Scholar
Rietjens, JAC, Sudore, RL, Connolly, M, et al. ; European Association for Palliative Care (EAPC) (2017) Definition and recommendations for advance care planning: An international consensus supported by the European Association for Palliative Care. Lancet Oncology 18, e543e551.CrossRefGoogle ScholarPubMed
Seymour, J, Almack, K and Kennedy, S (2010) Implementing advance care planning: A qualitative study of community nurses’ views and experiences. BMC Palliative Care 9, 4.CrossRefGoogle ScholarPubMed
Schellinger, S, Sidebottom, A and Briggs, L (2011) Disease specific advance care planning for heart failure patients: Implementation in a large health system. Journal of Palliative Medicine 14, 12241230.CrossRefGoogle Scholar
Simón Lorda, P, Tamayo Velázquez, MI and Esteban López, MS (2013) Advance care planning. Support guide for professionals. Sevilla: Junta de Andalucía. Consejería de Salud y Bienestar Social. In Spanish.Google Scholar
Street, A and Ottmann, G (2006) State of the Science Review of Advance Care Planning Models. La Trobe University, Bundoora. Available at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.568.5355&rep=rep1&type=pdf.Google Scholar
Sudore, RL, Knight, SJ, McMahan, RD, et al. (2014) A novel website to prepare diverse older adults for decision making and advance care planning: A pilot study. Journal of Pain and Symptom Management 47, 674686.CrossRefGoogle ScholarPubMed
Sudore, RL, Lum, HD, You, JJ, et al. (2017) Defining advance care planning for adults: A consensus definition from a multidisciplinary Delphi Panel. Journal of Pain and Symptom Management 53, 821832.CrossRefGoogle ScholarPubMed
Tamayo-Velázquez, M I, Simón-Lorda, P, Villegas-Portero, R, et al. (2010) Interventions to promote the use of advance directives: An overview of systematic reviews. Patient Education and Counseling 80, 1020.CrossRefGoogle Scholar
Teno, JM, Nelson, HL and Lynn, J (1994) Advance care priorities for ethical and empirical research. The Hastings Center Report 24, s32s36.CrossRefGoogle ScholarPubMed
The SUPPORT Principal Investigators (1995) A controlled trial to improve care for seriously ill hospitalized patients. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). JAMA 274, 15911598.CrossRefGoogle Scholar
Weathers, E, O'Caoimh, R, Cornally, N, et al. (2016) Advance care planning: A systematic review of randomised controlled trials conducted with older adults. Maturitas 91, 101109.CrossRefGoogle ScholarPubMed
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