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Table 3 The ACP Medizinisch Begleitet© tool

From: Implementing advance care planning in early dementia care: results and insights from a pilot interventional trial

The ACP Medizinisch Begleitet© tool was developed by Zurich University Hospital and Palliative Zurich + Schaffhouse. Its structure and content are inspired from a German tool called « Behandlung im Voraus planen » [21], the American « Respecting Choices© » [15], and the Australian « Respecting Patients Choices© » [16].

ACP Medizinisch Begleitet© entails two distinct parts. In the first part, trained facilitators engage people in a structured discussion about life and death, quality of life, and past experiences with care. In the second part, people are encouraged by the facilitator to appoint a surrogate decision-maker and document advance directives in three distinct situations of lost decision-making capacity. The first situation is a sudden loss of decision-making capacity due to a vital emergency, for example cardiac arrest or acute respiratory distress, when rapid medical interventions could save the life of the person. The second situation is a loss of decision-making capacity for an uncertain period of time, for instance after a severe stroke when the patient is in intensive care and life-supporting treatment is still necessary. The third situation is a permanent loss of decision-making capacity, as in the case of long-standing unresponsive wakefulness syndrome (vegetative state) or advanced dementia. For each scenario, people are asked to choose a goal of care among “prolong life”, “prolong life with certain treatment limitations” and “comfort care only”. In order to support decision-making, the tool includes evidence-based decision aids about cardiopulmonary resuscitation, respiratory distress, dialysis, artificial nutrition, and place of death.

A dedicated training to facilitate ACP with this tool is available in German and in French, in Zurich and in Lausanne respectively. The training prepares healthcare providers to broach ACP, explain ACP Medizinisch Begleitet© structure and contents in lay terms, facilitate the interview, and document advance decision. Training with simulated patients helps trainees to anticipate the complexities of real-life ACP interviews. Between training sessions, trainees have to practice ACP; the examination consists in a teacher directly observing the trainees performing an ACP with one of their patients.