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Trends between 2009 and 2014 in advance care planning for older people in Belgium and the Netherlands.

Penders, Y.W.H., Deliens, L., Onwuteaka-Philipsen, B., Donker, G.A., Moreels, S., Block, L. van den. Trends between 2009 and 2014 in advance care planning for older people in Belgium and the Netherlands. European Journal of Public Health: 2016, 26(suppl. 1) Abstract: 9th European Public Health Conference All for Health, Health for All Vienna, Austria 9–12 November 2016
Background
Advance care planning (ACP) is of particular importance for older people and those at risk of cognitive decline at the end of life. While ACP has gained attention from practice and policy-makers over the past decades, there are no studies evaluating trends in physician’s awareness of patient preferences.

Methods
Retrospective survey regarding deceased patients among a cohort of representative nationwide GP sentinel networks in 2009, 2010, 2013 and 2014 in Belgium and the Netherlands. Patients who died non-suddenly aged 65 years or older were included in the study. GPs were asked about patient preferences for a medical treatment at the end of life; whether or not a proxy decision maker was known; and whether or not this proxy decision maker was consulted if a situation arose where this was necessary.

Results
GPs were aware of a preference for a medical treatment at the end of life increased in Belgium (n = 2785) for 27% of decedents in 2009 to 40% in 2014 and in the Netherlands (n = 1083) from 53% to 66%. Awareness of a preference for a proxy decision maker increased in Belgium from 29% in 2009 to 43% in 2014 and in the Netherlands from 30% to 57%, with the preference being recorded in writing in a fifth to a third of cases in both countries (borderline significant decrease in the Netherlands from 28% to 25%, p = 0.05). These trends were significant in all studied patient groups. In the majority of cases where the situation arose, proxy decision makers were consulted at the end of life in both countries (71%-96%), though Dutch GPs more often indicated that no such situation arose (61%).

Conclusions
GPs were much more frequently aware of their patients’ preferences in 2014 than in 2009 in both countries, which suggests that increased attention to ACP is bringing rapid change

Key messages:
•Between 2009 and 2014, physician’s knowledge of patients' preferences regarding care at the end of life increased significantly in both Belgium and the Netherlands
•Rapid improvement in advance care planning is possible, with some indicators doubling in only 6 years