Effectiveness of interventions to increase participation in advance care planning for people with a diagnosis of dementia

摘要

The benefits of advance care planning are well documented and there is a developing evidence base that supports its value. The person with a life-limiting illness has the opportunity to maintain their autonomous voice in facilitating improved end-of-life care outcomes; in addition, there is evidence to demonstrate the positive impact on their family and carers, with reduction in incidences of depression, stress and anxiety. However, for those living with dementia, there are many challenges to advance care planning, including the issue of loss of capacity as a certainty with disease progression, and identifying the most appropriate time to address advance care planning discussions. Yet advance care planning for those living with dementia is acknowledged to be much needed; drivers such as the identified suboptimal end-of-life care for people with dementia, including higher incidence of invasive care, alongside the recognition that the disease process leads to a loss of capacity to make informed decisions as physical and mental condition declines with progression.