Shared care plan: an extraordinary tool for the personalisation of medicine and respect for self-determination

Main Article Content

Greta Bevilacqua
Matteo Bolcato
Daniele Rodriguez
Anna Aprile

Keywords

informed consent, shared care plan, advance treatment directive, blood refuse, patients’ self-determination

Abstract

BACKGROUND. On 22 December 2017, Law No. 219 was approved in Italy. This law provides citizens with effective tools with which to express healthcare decisions: namely, advance treatment directives (ATD) and shared care plans (SCP).


METHODS. This article presents an analysis of 70 SCP cases carried out in a tertiary hospital in Italy during the period between 01.02.2018 and 29.02.2020 inclusive.


RESULTS. In 90% of cases, the objective of the plan pertained to situations regarding patients’ refusal of transfusions of blood components, the majority (97%) due to their belonging to the religious movement of Jehovah’s Witnesses. 46% of the sample had drafted ATDs. The course of treatment recommended by the attending physicians was confirmed in 93% of the SCP cases. Trustees were appointed in 96% of cases. In 55% of cases, patients assigned trustees with attestative functions and the remaining 45% with creative functions. The results demonstrate that each patient personally dictates his or her wishes and the role assigned to the trustee. SCP meetings serve as a useful tool for providing the patient and his or her relatives with information, and for appointing a trustee. However, it has never been necessary to solicit the intervention of the trustee following a surgical operation.


CONCLUSIONS: The SCP has proven to be an essential tool in achieving the objective of personalised medicine. However, there is still notable passivity in its application. Further effort is required in order for it to become a common asset in clinical practice.

a

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...
Abstract 9 |

References

[1] Di Paolo M, Gori F, Papi L, Turillazzi E. A review and analysis of new Italian law 219/2017: 'provisions for informed consent and advance directives treatment'. BMC Med Ethics. 2019;20(1):17
[2] Di Luca A, Del Rio A, Bosco M, Di Luca NM. Law on advance health care directives: a medical perspective. Clin Ter. 2018;169(2):e77-e81
[3] Viola RV, Di Fazio N, Del Fante Z et al. Rules on informed consent and advance directives at the end-of-life: the new Italian law. Clin Ter. 2020;171(2):e94-e96.
[4] Cinnella G, Lo Presti C. Perspectives concerning the law on Advance Directives and Advance Care Planning and their effects on end-of-life care in Italian Intensive Care Units. Minerva Anestesiol. 2019;85(4):338-341
[5] Gristina GR, Busatta L, Piccinni M. The Italian law on informed consent and advance directives: its impact on intensive care units and the European legal framework. Minerva Anestesiol. 2019;85(4):401-411
[6] Ciliberti R, Gorini I, Gazzaniga V, De Stefano F, Gulino M. The Italian law on informed consent and advance directives: New rules of conduct for the autonomy of doctors and patients in end-of-life care. J Crit Care. 2018;48:178-182
[7] Ciliberti R, Gulino M, Gorini I. New italian law about end of life: self-determination and shared care pathway. Recenti Prog Med. 2018;109(5):267-271
[8] Barbisan C. Legge 219: tormenti, chiarezze, insidie. Forum - La legge n. 219 del 2017, Norme in materia di consenso informato e di disposizioni anticipate di trattamento. BioLaw J. 2018;1;13-15.
[9] Pizzetti FG. Prime osservazioni sull’istituto delle disposizioni anticipate di trattamento (DAT) previsto dall’articolo 4 della legge 22 dicembre 2017, n. 219. Forum - La legge n. 219 del 2017, Norme in materia di consenso informato e di disposizioni anticipate di trattamento. BioLaw J. 2018;1;54-60.
[10] Solarino B, Bruno F, Frati G, Dell'Erba A, Frati P. A national survey of Italian physicians' attitudes towards end-of-life decisions following the death of Eluana Englaro. Intensive Care Med. 2011;37(3):542-549.
[11] Rubulotta F, Rubulotta G, Santonocito C et al. End-of-life care is still a challenge for Italy. Minerva Anestesiol. 2010;76(3):203-208.
[12] Gristina GR, De Gaudio R, Mazzon D, Curtis JR. End of life care in Italian intensive care units: where are we now? Minerva Anestesiol. 2011;77(9):911-920.
[13] Moreschi C, Da Broi U, Rodriguez D et al. The Eluana Englaro Case: cause of death after the withdrawal of artificial nutrition and hydration in a subject in a permanent vegetative state and with quadriplegia. Forensic Sci Int, 2013;231(1-3):e24-9.
[14] Aprile A, Piccinni M. Art. 5 – Pianificazione condivisa delle cure. In Barba A, Pagliantini S. Commentario del Codice Civile-Delle Persone–Vol. II. Ed. UTET Giuridica. 2019;1604-1621.
[15] Casonato C. Taking sick rights seriously: la pianificazione delle cure come paradigma di tutela delle persone malate. Riv It Med Leg. 2018;3;949-963.
[16] Benciolini P. Art. 5 “Pianificazione condivisa delle cure”. Forum - La legge n. 219 del 2017, Norme in materia di consenso informato e di disposizioni anticipate di trattamento. BioLaw J. 2018;1;64-65.
[17] Veronesi P. La pianificazione condivisa delle cure. Forum - La legge n. 219 del 2017, Norme in materia di consenso informato e di disposizioni anticipate di trattamento. BioLaw J. 2018;1;66-69.
[18] Giardina F. Il fiduciario. Forum - La legge n. 219 del 2017, Norme in materia di consenso informato e di disposizioni anticipate di trattamento. BioLaw J. 2018;1;61-63
[19] Di Rosa G. La rete di prossimità e il ruolo del fiduciario. Responsabilità Medica. 2019; 1; 49-53.
[20] Veshi D, Koka E, Venditti C. L’importanza del fiduciario nelle decisioni di fine vita in alcuni paesi dell’Europa occidentale. Riv It Med Leg. 2018;3;904-914.
[21] Benciolini P. La “Medicina Legale Clinica”. Riv It Med Leg. 2005;3;451-459.
[22] Bolcato M, Fassina G, Rodriguez D, Russo M, Aprile A. The contribution of legal medicine in clinical risk management. BMC Health Serv Res. 2019;19(1):85.
[23] Farmer SL, Trentino K, Hofmann A et al. A Programmatic Approach to Patient Blood Management – Reducing Transfusions and Improving Patient Outcomes. Open Anesthesiol J 2015;9:6–16.
[24] Isbister JP. The three-pillar matrix of patient blood management-An overview. Best Pract Res Clin Anaesthesiol 2013;27:69–84.
[25] Hofmann A, Farmer S, Shander A. Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management. Oncologist 2011;16:3–11.
[26] Franchini M, Marano G, Veropalumbo E et al. Patient Blood Management: A revolutionary approach to transfusion medicine. Blood Transfus 2019;17:191–5.
[27] Vaglio S, Gentili S, Marano G et al. The Italian Regulatory Guidelines for the implementation of Patient Blood Management. Blood Transfus. 2017 Jul;15(4):325-8.

DB Error: Unknown column 'Array' in 'where clause'