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Guidelines on Advance Statements and Advance Directives - PowerPoint PPT Presentation


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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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Presentation Transcript
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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
stakeholders
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
methodology
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
grading of evidence
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  • Draft guidance from systematic review will be disseminated to GC and meeting held to discuss each of the recommendations
recommendations
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
scope of guidelines
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
questions addressed
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
action plan
Action Plan
  • External Review process – RCP will review final draft and may co-badge
  • Development of Audit Standards
  • Dissemination plan