OP80 Shared care planning: a new model to integrate advance care planning into community. The basque country experience

Abstract

<h3></h3> In the Basque Country, a project has been implemented based on community education, the training of health and social workers. It tries to elicit the individual’s preferences and encourages them to take part in planning their care. Writing down advance directives is not the main aim. The target population is chronic patients, elderly people and anyone at the end of life. The project also includes everyone who wants to think about the process of dying and needs to have a conversation related to this topic. The project started in 2014 as a bottom-up project and it has grown into a top-down project performed in the whole Basque Health Service. <h3>Results</h3> More than one hundred conferences and debates have been taking place in neighborhood associations, cultural centers, libraries or educational centers. More than five thousand people have attended these activities. 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 have been created in order to explain the project and to make it easier to understand. The keystone is the training of health and social workers in order to answer citizens’ requests and to integrate the conversations into everyday care.