Beschreibung:
<jats:title>Abstract</jats:title>
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<jats:title>BACKGROUND</jats:title>
<jats:p>Advance care planning (ACP) enables competent patients to define goals and preferences for future treatments and care, to discuss these goals and preferences with relatives, and if appropriate to record these preferences [1]. After many years of political and social debates, in December 2017 the first advance directive and care planning legislation was approved in Italy. In the last years, several national recommendations released by political institutions and medical associations have underlined the importance of conducting ACP with chronic patients, included dialyses patients. Nevertheless, citizens’ awareness of these issues is scarce as well as the integration of the ACP process into clinical routine [2].</jats:p>
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<jats:title>METHOD</jats:title>
<jats:p>Since November 2020, our nephrology unit adopted a protocol aimed to conduct ACP interventions with dialysis patients. Firstly, all patients were informed about the possibility to taking part in one or more ACP conversations with their nephrologist. Secondly, a semi-structured guide to the conversation was created in order to support physicians in conducting the ACP intervention. The guide is divided into three sections: (1) exploring patient's understanding of the disease and his/her hopes and life goals; (2) patient's social relationships; (3) preferences for future treatments and care (e.g. CPR, dialysis, palliative care, etc). Finally, patients along with nephrologist and their relatives can document their preferences.</jats:p>
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<jats:title>RESULTS</jats:title>
<jats:p>Of 110 haemodialysis patients, 40 treated in our centre asked for an ACP intervention and filled-in an advance directive. Specifically, no patients required an immediate discontinuation of dialysis; nevertheless, 70% of them stated that would not like to continue with dialysis in case he/she was no longer able to self-determine (e.g. permanent loss of capacity to communicate with others). Most of patients (90%) have appointed a personal representative (usually their partner). In the eventuality of cardiac arrest, 55% of patients asked for cardiopulmonary resuscitation. Pain control and palliative care was the overall most cited topic. The fear of being a burden on family members has been frequently expressed by not independent patients. Regarding the last phase of life, 75% of patients expressed the desire to stay at home, the others in hospice.</jats:p>
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<jats:title>CONCLUSION</jats:title>
<jats:p>ACP process is very recent in Italy and not well known by patients and healthcare providers (HCPs). As a result, discussions about future treatments and care are rarely included in the clinical routine with haemodialysis patients. Training of HCPs on these issues as well as the use of procedures tailored to the Italian context for conducting ACP interventions is needed.</jats:p>
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