1285 Preferences of residents of nursing homes: descriptive analysis of advance care planning documents

<h3>Background</h3> Residents of nursing homes (NH) have a high risk of life-threatening illness. In Germany residents are only treated consistent with their well-informed preferences in around 1/5 of such situations. Advance Care Planning (ACP) facilitation and the resulting ACP documents aim to improve this in cases of loss of decision-making. For this improvement, it is relevant that medically relevant, meaningful and sufficiently detailed preferences are documented. <h3>Research Question</h3> What are the preferences of NH residents in the event of a life-threatening illness accompanied by loss of decision-making, if they are given the opportunity to develop these in an ACP facilitation? <h3>Method</h3> As part of the BEVOR trial, the existence of ACP documents (advance directives (AD) and AD-by proxy) in accordance with the standards of ACP Germany was recorded by trained facility staff from all resident files in the care facilities of the intervention group. <h3>Results</h3> In 2,343 residents, 348 documents guiding emergency care were found, 40% (152) of which were made by proxies. 25% (94) showed preference for purely palliative care in an acute life-threatening event, 61% (231) agreed to be hospitalised for life-sustaining therapy, 44% (168) to intensive care treatment and 16% (59) to resuscitation. In the case of hospital treatment with incapacity to consent of unclear duration, 20% (65) preferred only palliative care, 75% (246) made restrictions on treatments in the further course of the illness. In case of permanent incapacity to consent, 64% (211) preferred only palliative care, 34% (112) made differentiated restrictions on treatments. <h3>Conclusion</h3> In order to enable residents of NH to be treated according to their own preferences if they are unable to give consent, a differentiated analyses of various medical scenarios and the documentation of the preferences thus developed is necessary. <h3>Unique Contribution</h3> These results can help to make ACP facilitation more effective and improve the quality of patient-centred decision-making for life-sustaining treatments. <h3>Implications</h3> Our results show that detailed ACP facilitation is useful in NH, as residents used the opportunity to define their differentiated preferences depending on the medical situations.