Einflussfaktoren auf die Inanspruchnahme von Advance Care Planning aus der Sicht von Angehörigen. Eine qualitative Analyse.

Ensuring autonomy at the end of life and enabling a dignified death are the main themes of palliative care research. Although living wills have been legally anchored since 2009 and important extensions were made by the Hospice and Palliative Care Act of 2016, too many people still receive too much or not the desired medicine at the end of life. Advance care planning, a conversational process to determine patients' wishes, has its origins in Anglo-American countries and has found its way into Germany. Among others, it is currently being used in Germany under the name “Behandlung im Voraus Planen”. In addition, the topic is also attracting increasing scientific interest. A number of open questions also concern the role and inclusion of relatives in an ACP process. Therefore, the present work explores factors influencing the use of ACP from the perspective of relatives (caregivers). For this purpose, caregivers were interviewed whose sick relatives were in a particularly relevant treatment situation (palliative oncological patients). The focus was on the question of barriers and facilitating factors as well as preferences for a suitable point in time and the desired initiator. A qualitative procedure was chosen for the evaluation, using the qualitative content analysis of Mayring. From the results of the analysis, a model of factors influencing the use of ACP from the perspective of the relatives was developed. A distinction can be made between systemic and personal factors. These are framed by the aspects of time and communication as comprehensive influencing factors. The implementation of access to ACP processes in the sense of "omnipresent electiveness", coupled with the consideration of beneficial "external conditions", can have a helpful effect on ACP claims from the outside. From the perspective of the relatives, a number of “initiator skills” play a role. Empowered by this, they are responsible for considering the other factors "type of family relationship" (internal family and individual aspects) and "the participator" (supra-individual aspects). The knowledge gained gives reason to assume that caregivers need more space in everyday medical practice when it comes to determining the will of their relatives. This aspect should not only be considered in the context of ACP processes.