Advance directive consultations - A study of selected consultation services in the Munich region

Abstract

So far, advance directives (AD) are often used ineffectively in Germany. Counseling for advance directives is neither legally required nor are quality standards available. Little is known about the structure and content of the counseling offered by the many different providers. The goal of this study was to assess the current practice and possible improvements of AD consultations by different professional groups in the Munich region in Germany compared to international Advance Care Planning (ACP) programs as best practice models. An explorative online survey (using the Likert scale) of general practitioners, notaries, nurses and hospice workers in the Munich area was conducted. The data were analyzed using SPSS and Excel. Content and structure of counseling services differ not only between but also within counseling groups, sometimes considerably. Consultations mostly last up to 60 minutes and included 1-2 sessions. Despite the fact that most counselors (46-79 % in the respective groups) favor routinely offered consultations, most counseling sessions are initiated by the consulted individuals themselves. Among other things, counseling sessions cover the topics of hydration (often / always [o / a] 69-97 %), permanent unconsciousness (o / a 48-94 %) and terminal illnesses (o / a 77-97 %). Especially the participation of future legal representatives in the counseling sessions (o / a 18-85 %), the drafting of emergency plans (0-45 %) and the completion of advance directives within the counseling session (29-51 %) was heterogeneous. The current counseling practice for advance directives varies considerably and does not yet reliably meet the best practice standards of ACP programs. This study thus underscores the need for comprehensive ACP programs.