Shared Care Planning: A new model to integrate Advance Care Planning into community. The Basque Country experience.

摘要

Advance Care Planning (ACP) has been mainly based on advance directives and their registration, according to legal requirements. The main objectives have often been forgotten: promoting citizen participation in shared decision-making and improving the quality of health care. The main barriers are the lack of information for citizens, nurses' and doctors' workloads and poor training in subjects like ACP, bioethics and communication. In the Basque Country, a new project has been implemented based on community education, the training of health and social workers and conversations with citizens. We have called it Shared Care Planning (SCP). It tries to elicit the individual’s preferences and encourages them to take part in planning their care and decisions. Writing down advance directives is not the main aim of the program; the aim is less papers and more conversations. The target population is chronic patients, elderly people and anyone at the end of life. The project also includes everyone who, after experiencing an illness or caring for relatives or friends, wants to think about the process of dying and needs to have a conversation related to this topic with their doctor, nurse or social worker. The project started in 2014 in two health centers in Vitoria-Gasteiz as a bottom-up project and, according to initial results and evaluations, it has grown into what can now be considered a top-down project performed in the whole Basque Health Service. Results.- Community education: More than one hundred conferences and debates have been taking place in neighborhood associations, cultural centers, libraries, city halls or educational centers. More than four thousand people have attended these activities. Training of health and social workers: One thousand workers have attended a basic training course, more than 500 workers have been trained as SCP facilitators and more than 700 doctors and nurses have participated in conversations with patients and families helped by an SCP facilitator. In 75% of cases, the citizens asked to be included after attending a conference; only 25% of participants were included because of a doctor or nurse’s invitation. Many support documents like interview guides, videos, posters and leaflets have been created in order to explain the project and to make it more accesible and easier to understand. SCP promotes citizen participation in shared decision-making and the integration of social and health care because it is based on community education, the coordination of different levels of care and the training of health and social workers. The project is growing in our community and it can be implemented in other regions and countries in the same way. Our experience shows that people want to participate in shared decision-making because, after a explanation of the main aims of SCP, they asked to be involved in this kind of communication process. The keystone is the training of health and social workers in order to answer citizens’ requests and to integrate in the ordinary caring for chronic patients and elderly people conversations about values, preferences, quality of life and the process of dying.