原创力文档a complex regional intervention to implement advance care planning in one towns nursing homes protocol of a controlled inter-regional study复杂的区域实现推进护理干预规划在一个城镇的疗养院受控区域研究的协议.pdfVIP
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a complex regional intervention to implement advance care planning in one towns nursing homes protocol of a controlled inter-regional study复杂的区域实现推进护理干预规划在一个城镇的疗养院受控区域研究的协议
in der Schmitten et al. BMC Health Services Research 2011, 11:14
/1472-6963/11/14
STUDY PROTOCOL Open Access
A complex regional intervention to implement
advance care planning in one town’s nursing
homes: Protocol of a controlled inter-regional study
1* 2 1 3 4 4
Jürgen in der Schmitten , Sonja Rothärmel , Christine Mellert , Stephan Rixen , Bernard J Hammes , Linda Briggs ,
Karl Wegscheider5, Georg Marckmann6
Abstract
Background: Advance Care Planning (ACP) is an emerging strategy to ensure that well-reflected, meaningful and
clearly documented treatment preferences are available and respected when critical decisions about life-sustaining
treatment need to be made for patients unable to consent. In Germany, recent legislation confirms that advance
directives (AD) have to be followed if they apply to the medical situation, but implementation of ACP has not yet
been described.
Methods/Design: In a longitudinal controlled study, we compare 1 intervention region (4 nursing homes [n/hs],
altogether 421 residents) with 2 control regions (10 n/hs, altogether 985 residents). Inclusion went from 01.02.09 to
30.06.09, observation lasted until 30.06.10. Primary endpoint is the prevalence of ADs at follow-up, 17 (12) months after
the first (last) possible inclusion. Secondary endpoints compare relevance and validity of ADs, process quality, the rate of
life-sustaining interventions and, in deceased residents, location of death and intensity of treatment before death. The
regional multifaceted intervention on the basis of the US program Respecting Choices® comprises training of n/h staff
as facilitators, training of General Practitioners, education of hospital and ambulance staff, and developmen
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