Advance care planning in nursing homes in Flanders, Belgium

The focus of this project is broadened to 'advance care planning' (ACP) in nursing homes in Flanders, Belgium.

Some aspects of the study design were tested in a pilot study. It was showed that decisions to withhold or withdraw food and/or fluids in nursing homes are more and more integrated into the global patient's file, where also other medical end-of-life decisions can be documented (as well ACP as actual care decisions).
It is necessary to investigate this as a whole, in order to understand practice concerning withholding or withdrawing of food and/or fluids.

ACP enables caregivers to handle as much as possible according to the patient's wishes when he/she has become incompetent. In other countries, patients get more and more opportunities by law to participate in medical decision-making (e.g. 'Patient Self Determination Act' in the United States). However, studies in these countries showed that ACP was documented only for a minority of the nursing home residents.
In Flanders, one can only appeal to the 'Patients' Rights Act' for this matter, and recently also to the 'Belgian Medical Deontological Code'. Until now, it has never been investigated for how many nursing home residents in Flanders ACP is documented, how many nursing homes have an ACP policy, and what the form and content of this policy is. Moreover, it is still unknown if the existence of an ACP policy and/or the availability of palliative care in the nursing home correlates with the care for patients at the end of life (e.g. number of transfers, place of death, documentation of ACP in the patients' files). This study will investigate these matters.