REVIEW – February 2015

Advance care and treatment planning through end-of-life decision making

Authors: Ireen Bruus, Mare Kellamäe, Maarja Kivirüüt

Articles PDF


Advance care planning, or development of advance directives is a process that involves the decisions made by the patient about his future health care. The decisions will be implemented in the event the patient is not able to do it himself/herself due to his/her health condition. Advance directives related to treatment and nursing care may be provided in the written form (living will) or orally (wishes forwarded to an authorised representative of health care). Advance directives provide the patient an opportunity to clearly identify the conditions/diseases that the patient expects to be treated and those he/she does not wish to be treated; what treatment he/she is ready to tolerate and what treatment he/she is not ready to tolerate; what kind of disabilities he/she is ready to live with and what kind he/she is not. Advance care planning is more frequently used in intensive care and oncology, in case of dementia syndrome and in the case of HIV treatment. Implementation of advance directives improves end of life care for the patient and increases satisfaction of the patient and his/her family, and reduces the anxiety, stress and sadness of next of kin. Despite the positive impact of advance care planning on patients, there are a number of shortcomings related to its implementation.