Proactive advance care planning

Runtime: January 2023 – December 2025
Funder: ZonMW

Project description

Advance care planning – that is, mutual decision-making between patients, informal caregivers, and care professionals on future care – is increasingly foregrounded as a promising practice for delivering value-based healthcare at the end of life. The promises of advance care planning (ACP) are many; it can result in care that is patient-centered, reduce overtreatment, prevent crisis situations, and lower healthcare costs. Embedding ACP in healthcare practice, however, is notoriously difficult as this requires continuous coordination of care over various domains (social care, first and second line care); a clear task and role division between formal and informal caregivers in the network around a patient, and a dynamic conversation about and reporting of wishes of future care. In this action research project, ESHPM helps healthcare providers in the Achterhoek - a region in the East of the Netherlands – to embed ACP in care practices for various patient groups, such as persons with COPD, heart conditions and older persons with complex care needs living at home. From 2023 until late 2025, researchers follow various patient journeys longitudinally and investigate how the conversation about future care develops between patients, informal and formal care givers, how this translates in agreements on future care, how these agreements are recorded and where, and how future care is informed by these recorded agreements. Insights from this research are fed back short-cyclically to healthcare providers in the region to improve ACP practices for selected target groups.     


Jitse Schuurmans (project coordinator); Estella Posthuma (PhD candidate); Nienke van Pijkeren (senior researcher); Roland Bal (professor of healthcare governance); Iris Wallenburg (professor of the sociology of care).  

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