Construction and content validation of an Advance Directive Document form for advance care planning in Colombia: a Delphi study
Abstract
Introduction: The advance directive document (ADD) is intended to align medical care and treatment with the person's goals and preferences in clinical scenarios where they are unable to communicate and decide. It is a priority to promote the creation of the ADD in patients with serious illnesses as part of the advance care planning (ACP) process.
Objective: To construct and validate the content of an ADD form with an interdisciplinary approach.
Methods: Qualitative study using the Delphi technique. The study comprised three iterative rounds of online surveys involving healthcare professionals and professors from the country. In round 1, panelists evaluated the components of the sample form and suggested new ones. In round 2, they assessed their level of agreement with the components suggested in round 1. In round 3, using the results from round 2, the final ADD form was developed.
Results: A structured ADD form was developed, containing ethical, clinical, and legal criteria.
Conclusions: A structured ADD form with high-quality content is presented for completion and formalization in the framework of a deliberative process exclusively between the doctor and the patient. It is available for partial or total adoption by patients, doctors, healthcare institutions, and palliative care services throughout Colombia.
References
Lasmarías C, Delgado S, Rietjens J, Korfage I, Gómez-Batiste X. Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care. Med Paliat. 2019;26(3):236-49. https://doi.org/10.20986/medpal.2019.1019/2018
Sedini C, Biotto M, Crespi Bel'skij LM, Moroni Grandini RE, Cesari M. Advance care planning and advance directives: an overview of the main critical issues. Aging Clin Exp Res. 2022;34(2):325-30. https://doi.org/10.1007/s40520-021-02001-y
Jiménez G, Tan WS, Virk AK, Low CK, Car J, Ho AHY. Overview of systematic reviews of advance care planning: Summary of evidence and global lessons. J Pain Symptom Manage. 2018;56(3):436-59. https://doi.org/10.1016/j.jpainsymman.2018.05.016
Calvache JA, Moreno S, Prue G, et al. Knowledge of end-of-life wishes by physicians and family caregivers in cancer patients. BMC Palliat Care. 2021;20(140). https://doi.org/10.1186/s12904-021-00823-1
Houben CHM, Spruit MA, Groenen MTJ, Wouters EFM, Janssen DJA. Efficacy of advance care planning: a systematic review and meta-analysis. J Am Med Dir Assoc. 2014;15(7):477-89. https://doi.org/10.1016/j.jamda.2014.01.008
Ministerio de Salud y Protección Social. Resolución 2665 de 2018 [Internet]. 2018 [cited: 2025 Jan 28]. Available at: https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%20No.%202665%20de%202018.pdf
Buck K, Nolte L, Sellars M, Sinclair C, White BP, Kelly H, et al. Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators. Health Expect. 2021;24(4):1312-25. https://doi.org/10.1111/hex.13264
Álvarez Acuña AM, Buitrago Martín CL, Ceballos Vejarano A. Content of the advance directives form of the pain and palliative care services in Colombia. Cross-sectional study. Colombian Journal of Anesthesiology. 2023;52(2):e1093. https://doi.org/10.5554/22562087.e1093
Luckett T, Bhattarai P, Phillips J, Agar M, Currow D, Krastev Y, et al. Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria. Aust Health Rev. 2015;39(5):552-60. https://doi.org/10.1071/AH14187
Junger S, Payne SA, Brine J, Radbruch L, Brearley SG. Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review. Palliative Med. 2017;31:684-706. https://doi.org/10.1177/026921631769068
Baker J, Lovell K, Harris N. How expert are the experts? An exploration of the concept of 'expert' within Delphi panel techniques. Nurse Res. 2006;14(1):59-70. https://doi.org/10.7748/nr2006.10.14.1.59.c6010
Keeney S, Hasson F, McKenna H. Consulting the oracle: ten lessons from using the Delphi technique in nursing research. J Adv Nurs. 2006;53(2):205-12. https://doi.org/10.1111/j.1365-2648.2006.03716.x
Ministerio de Salud y Protección Social. Resolución 971 de 2021 [Internet]. 2021 [cited: 2024 Aug. 1]. Available at: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/resolucion-971-de-2021.pdf
Ministerio de Salud y Protección Social. Resolución 229 de 2020 [Internet]. 2020 [cited: 2025 Jan. 28]. Available at: https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%20No.%20229%20de%202020.pdf
Richard A, Richard J, Johnston W, Miyasaki J. Readability of advance directive documentation in Canada: a cross-sectional study. CMAJ Open. 2018;6(3):E406-E11. https://doi.org/10.9778/cmajo.20180037
Mueller LA, Reid KI, Mueller PS. Readability of state-sponsored advance directive forms in the United States: a cross sectional study. BMC Med Ethics. 2010;11:6. https://doi.org/10.1186/1472-6939-11-6
You JJ, Allatt P, Howard M, et al. Short graphic values history tool for decision making during serious illness. BMJ Supportive & Palliative Care. 2022;12:e777-e784. https://doi.org/10.1136/bmjspcare-2018-001698
Sudore RL, Landefeld CS, Barnes DE, Lindquist K, Williams BA, Brody R, Schillinger D. An advance directive redesigned to meet the literacy level of most adults: a randomized trial. Patient Educ Couns. 2007;69(1-3):165-95. https://doi.org/10.1016/j.pec.2007.08.015
Akdeniz M, Yardımcı B, y Kavukcu E. Ethical considerations at the end-of-life care. SAGE. 2021:1-9. https://doi.org/10.1177/20503121211000918
Moore N, Detering K, Low T, Nolte L, Scott Fraser S, Sellars M. Doctors’ perspectives on adhering to advance care directives when making medical decisions for patients: an Australian interview study. BMJ. 2019:9-11. https://doi.org/10.1136/bmjopen-2019-032638
República de Colombia, Corte Constitucional. Sentencia T-060 de 2020 [Internet]. 2020 [cited: 2024 Aug. 1]. Available at: https://www.corteconstitucional.gov.co/relatoria/2020/T-060-20.htm
República de Colombia, Corte Constitucional. Sentencia C-233 de 2021 [Internet]. 2021 [cited: 2024 Aug. 1]. Available at: https://www.corteconstitucional.gov.co/Relatoria/2021/C-233-21.htm
Congreso de la República de Colombia. Ley 1996 de 2019 [Internet]. 2019 [cited: 2024 Aug. 1]. Available at: http://www.secretariasenado.gov.co/senado/basedoc/ley_1996_2019.html
Mohan D, Sacks OA, O'Malley J, et al. A new standard for advance care planning (ACP) conversations in the hospital: Results from a Delphi Panel. J Gen Intern Med. 2021;36(1):69-76. https://doi.org/10.1007/s11606-020-06150-0
Scholten G, Bourguignon S, Delanote A, Vermeulen B, Van Boxem G, Schoenmakers B. Advance directive: does the GP know and address what the patient wants? Advance directive in primary care. BMC Med Ethics. 2018;19(1):58. https://doi.org/10.1186/s12910-018-0305-2
Da Silva MAP, Corradi-Perini C. The mapping of influencing factors in the decision-making of end-of-life care patients: A systematic scoping review. Indian J Palliat Care. 2023;29(3):234-42. https://doi.org/10.25259/IJPC_292_2022
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