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Rapid response to:


The impact of advance care planning on end of life care in elderly patients: randomised controlled trial

BMJ 2010; 340 doi: (Published 24 March 2010) Cite this as: BMJ 2010;340:c1345

Rapid Response:

Uptake of advance care planning also depends on public education

Detering and colleagues1 have contributed valuable evidence from an
RCT showing the positive impact of advance care planning (ACP) on
adherence to patients’ wishes and improved outcomes for surviving family
members. However, a high proportion (over 50%) of those assessed for
trial eligibility was excluded due to being judged as ‘not competent’, or
‘non-English speaking’. We agree with the authors in their assessment
that these patients are likely to be underserved and that ACP could be
especially beneficial in these groups.

The authors highlight the importance of education for health care
staff and the importance of giving patients the opportunity for ACP whilst
they are still able to make decisions for themselves. However,
professional education is likely to have limited impact without addressing
needs for wider public education on ACP using methods and materials that
are appropriate for culturally diverse populations.

Previous research has found that older people often face cultural
barriers when trying to make their needs and preferences known for end-of-
life care2. In the UK, we have found that training volunteers to act as
peer educators in ACP and related issues in their own communities may be
one possible means of helping to mitigate such barriers3. However,
further evidence is required about the impact of such community based
initiatives on the take up of ACP among populations often excluded from
research and the long term outcomes of raising awareness about ACP in
community contexts.

1. Detering K, Hancock AD, Reade MC, Silvester W. The impact of
advance care planning on end of life care in elderly patients: randomised
controlled trial. BMJ 2010;340:c1345 doi:10.1136/bmj.c1345

2. Seymour JE, Payne S, Chapman A, Holloway M. Hospice or Home?
Expectations about end of life care among older white and Chinese people
living in the UK. Sociology of Health and Illness, 2007;29(6):872-890.

3. Clarke A, Sanders C, Seymour JE, Gott M, Welton, M. Evaluating a peer
education programme for advance end-of-life care planning: peer educators’
perspectives. International Journal on Disability and Human Development,
Special Issue, 2009; 8, 1:33-41.

Competing interests:
None declared

Competing interests: No competing interests

09 April 2010
Jane E Seymour
Sue Ryder Care Professor of Palliative and End of Life Studies
Caroline Sanders and Amanda Clarke
University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA