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228 Shared decision making and advance care planning: a systematic literature review and novel decision-making model
  1. Ana Rosca1,
  2. Isabelle Karzig2,
  3. Jürgen Kasper3,
  4. Tanja Krones2
  1. 1Stadtspital Zurich – Switzerland
  2. 2University Hospital Zurich – Switzerland
  3. 3Oslo Metropolitan Universita – Norway

Abstract

Introduction Shared decision making (SDM) and advance care planning (ACP) are important evidence and ethics based concepts and communication tools to aid the treatment decision-making process. Although recommended in the care of patients with risks of complications, SDM and ACP have not yet been described as components of one single process. We therefore aim to assess how SDM and ACP is being applied, choosing patients with aortic stenosis with high and moderate treatment complication risks such as bleeding or stroke as an example, and propose a model to best combine the two concepts and integrate them in the care process.

Methods To assess how SDM and ACP is applied in usual care, we performed a systematic literature review. The included studies have been analysed by means of thematic analysis and abductive reasoning to determine which SDM and ACP steps are applied, and to propose a model of combining the two concepts into one process.

Results (1) The search in multiple database revealed 15 studies. Eleven describe various steps of SDM while four studies discuss the documentation of goals of care. (2) We have developed an integrative SDM and ACP model (please see figure 1 below), which can be used in the treatment decision-making process of patients with risks of complications.

Conclusion Integration of SDM and ACP for patients with complications risks may ensure a continuous patient-centered support for short and long-term decisions and outcomes.

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