Advance care planning (ACP) as an element of clinical ethics support services - description and evaluation

Background Advance care planning (ACP) is increasingly practiced in Germany. While there have been funding possibilities for counseling offers in the tradition of ACP in nursing homes and facilities for integration assistance since 2015 and initial studies on offers have been published, there is a lack of published evaluation studies on ACP offers in hospitals in Germany.Intervention and methods Structured description of ACP services at a German university hospital. Quantitative content analysis of written documentation of conducted ACP conversation processes for the period from January 2020 to August 2021 (20 months).Results During the period, there were 93 ACP requests. In all, 110 discussions were held with 79 patients; 46% of requests came from patients receiving palliative care. On average, the consultations lasted 45 min. The process of creating an advance directive took an average of 122 min and 2.5 conversations. In 23% of the patients, the ACP process discontinued after the initial consultation. The process affected various areas of other professions in the hospital between physicians and patients.Conclusion The introduction of an ACP service in hospitals not only offers a multitude of opportunities, but also challenges that need to be overcome in a joint discourse. When embedding ACP services in a hospital, the specifics of the hospital must be considered and, in particular, the distinction between ACP and other services and tasks, e.g., current therapy goal setting or clinical ethics case consultation, must be defined.