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Guidelines on Advance Statements and Advance Directives

Guidelines on Advance Statements and Advance Directives. Aileen Fraser and Jane Buswell. Aim. To prepare a guideline on advance statements and advance decisions with particular reference to older people. Only one published guideline from North America of questionable methodology

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Guidelines on Advance Statements and Advance Directives

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  1. Guidelines on Advance Statements and Advance Directives Aileen Fraser and Jane Buswell

  2. Aim • To prepare a guideline on advance statements and advance decisions with particular reference to older people. • Only one published guideline from North America of questionable methodology • For all clinicians caring for adults who may complete an advance decision/statement

  3. Stakeholders • BGS, RCGP, Faculty of Old Age Psychiatry, RCN • User representation – Alzheimer’s society, Age Concern, Help the Aged, RCP – patient panel • Guideline Committee and Guideline Development Committee

  4. Methodology • AGREE – appraisals of guidelines • Systematic review in 2 phases – first phase for RCTs, Systematic reviews, evidence based guidelines and 2nd phase for other research – case control, surveys, cohort studies • If evidence lacking then case reports, expert consensus, conferences

  5. Grading of Evidence • Appraisal tools - initially using SIGN but more appropriate to RCTs • Piloted Van Tulder and NSF tools and NSF chosen for ease of use and agreement between reviewers • Draft guidance from systematic review will be disseminated to GC and meeting held to discuss each of the recommendations

  6. Recommendations • Recommendations based on strong evidence • Recommendations based on good evidence but where findings have to be extrapolated to be useful in clinical practice – extrapolation by consensus • Recommendations for which no evidence exists but which address important aspects of care – consensus on best practice

  7. Scope of Guidelines • Covers advance statements and decisions • Not disease specific • Adults (over 18 years) • Relevant evidence from all countries will be considered but guidelines will reflect legal situation in England and Wales • All settings where end of life care planning takes place

  8. Questions Addressed • Decided by scoping exercise and consultation with stakeholders • 21 RCTs and 1 Systematic review identified • 29 key questions covering attitudes, barriers, content, demand, outcomes and training • Size of samples – 66 papers for 1st question

  9. Action Plan • External Review process – RCP will review final draft and may co-badge • Development of Audit Standards • Dissemination plan

  10. Any Questions/Comments ?

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