Importancia de la Planificación de Decisiones Anticipadas en pacientes terminales

Written by: Dr. Christian Villavicencio-Chávez
Edited by: Alicia Arévalo Bernal

Advanced decision planning (PDA) in patients suffering from degenerative, advanced or terminal diseases is something that improves health management in the final stage of the patient's life. It is a procedure that would guarantee respect for the autonomy of patients when they lose the ability to decide. In addition, it provides them with health support, something essential for the patient and his family at this stage, avoiding invasive treatments that cause more emotional discomfort.

Patients likely to receive Advance Decision Planning

There are patients classified as Patients with Complex Chronic Disease (CCP) and Patients with Advanced Chronic Disease (MACA). The former have a prevalence of 3.5 - 5% of the population and are characterized by pluripatology. Its evolution is dynamic and requires a great use of emergency services, consumption of health resources, drugs and health care. On the other hand, patients with MACA account for 1.5% of the population, with a clinical profile similar to that of CCPs, but also suffer from a more serious clinical involvement, with a perception of limited life expectancy.

The PDA a procedure that would guarantee respect for the autonomy of patients when they lose the ability to decide.

What is Advance Decision Planning and what benefits does it bring?

PDA is a way to allow these groups of patients with advanced diseases, to express their will when they are in an irreversible process with poor prognosis. However, there are cases where it is difficult due to the patient's clinical or mental situation, since he can not express his will and are not documented in a medical history. This makes their preferences uncertain and generates discomfort in the family.

When should Advance Decision Planning be done and why?

If it is desired to perform a correct PDA, it is important to do so when the terminal disease is still at an early stage. It is important to emphasize that when the patient is not able to express his will and appear complications, it is the family that must participate in that decision-making. This is sometimes a complication, because the family is not aware of it, and they play an important role at the end of the patient's life.

It is important that the specialist in Geriatrics get good communication with the patient. In this way, it will allow you to transmit adequate information about the disease and take into account the patient's values, so that he may also participate in the decision-making process. To achieve this communication, professionals must be trained in attitudes, knowledge and communicative skills, always with the aim of properly accompanying the patient and the family, respecting their values ​​and desires in the last stage of life.

*Translated with Google translator. We apologize for any imperfection

By Dr. Christian Villavicencio-Chávez

Dr. Villavicencio-Chavez is a renowned specialist in Geriatrics with extensive training. He is currently the Medical Director of Caredoctors. He holds the title of Doctor of Health Sciences at the International University of Catalonia and Official Master of Palliative Care at the University of Vic and the University of Barcelona. Evaluation of Clinical Competence for palliative care physicians (ACOE) by the Institute of Health Studies and the Catalan-Balearic Society Pal·liatives Cures. Research Sufficiency (DEA) from the Autonomous University of Barcelona. Since 2013 it is part of a research group care for people at the end of life that is recognized by the Generalitat de Catalunya. He has worked as a specialist in palliative care service of the Catalan Institute of Oncology, for seven years. He is currently the director of the project LagunAdvance Vianorte-Laguna Foundation in Madrid and Barcelona Croupier Project on advance planning decisions. He combines his professional career with teaching as an Associate practicing Bioethics and Palliative Medicine professor at the Faculty of Medicine of the International University of Catalonia. He is the author of numerous publications and regular at national and international conferences.

*Translated with Google translator. We apologize for any imperfection

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