Following publications from a 33-country Delphi study on a definition of advance care planning in dementia, and on policy and research gaps, the core and final piece on clinical recommendations has now been published.

When, how and what to assess to optimize ACP in dementia: that’s what the paper is about. The optimal would be to address a full set of 30 elements of advance care planning, 25 of which to be addressed during every conversation or at least once. This may not be feasible in current practice, given the estimated median of four conversations needed to cover the elements.

They concluded that trade-offs between optimal advance care planning and feasibility in practice must be examined. Further, sensitivities of discussing end-of-life care or end of life more generally emerged with ambiguity among the Delphi panelists and even within the team of authors. Déjà vu: such divergences also appeared around a care goals model for persons with dementia, in that we could not agree on a, or the position of, life prolongation as a care goal for persons with dementia. Regardless, a person-centered, well-coordinated holistic approach is considered desirable by the panel, in line with the advice and wishes of seven Dutch persons with young-onset dementia residing in the community who contributed to this Delphi study.