Development and implementation of an advance care planning program in Catalonia, Spain

Palliat Support Care. 2019 Aug;17(4):415-424. doi: 10.1017/S1478951518000561.


Objective: Implementation of an advance care planning (ACP) program for people with advanced chronic conditions is a complex process. The aims of this paper are to describe (1) the development of the ACP program in Catalonia, Spain, for patients with advanced chronic conditions and complex needs and (2) the preliminary results of the implementation of this program in health and social services.

Method: The ACP program was developed and implemented in a four-stage process as follows: (1) design and organization of the project; (2) selection of the professionals to carry out the project; (3) creation of four working groups to develop the conceptual model, guidelines, training program, and perform a qualitative evaluation; and (4) project implementation.

Result: The following deliverables were completed: (1) conceptual framework document; (2) practical guidelines for the application of the ACP; (3) online training course (3,763 healthcare professionals completed the online course, with an overall satisfaction rating of 8.4 on a 10-point scale); and (4) additional training activities (conferences, short courses, and seminars) in between 2015 and 2017.

Significance of results: This project was led by the Catalan Ministry of Health. The strengths of the project development include the contribution of a wide range of professionals from the entire region, approval by the Catalan Bioethics Committee and the Social Services Ethics Committee, and the ongoing validation by members of the community. A standardized online training course was offered to all primary care professionals and included as a quality indicator for continuing education for those professionals in the period 2016-2020. The main outcome of this project is the establishment of a pragmatic ACP throughout the region and training of the health and social care professionals involved in the care of advanced chronic patients.

Keywords: Advance care planning; Chronic diseases; Health plan implementation; Palliative care; Training.

MeSH terms

  • Advance Care Planning*
  • Focus Groups / methods
  • Health Education / methods
  • Humans
  • Internet
  • Palliative Care / methods*
  • Program Development / methods
  • Qualitative Research
  • Spain
  • Teaching / standards*