1256 A global and comprehensive definition of advance care planning: results of an international Delphi-process
Bibliographic record
Abstract
Background Advance care planning (ACP) has been firstly mentioned in 1993 and used increasingly since 2010 in scientific literature. Since then several definitions have been published for ACP e.g. for specific groups of people (adults/persons with dementia) and regions (Asia). However, a global, inclusive and comprehensive definition and the structural elements necessary for ACP have not yet been developed, which makes it difficult to classify and compare studies on ACP and ACP programs. However, the ACP-i society considers such a broad definition to be necessary in order to improve the discourse and also the self-determined and person-centered care of patients. Research questions How can ACP be defined globally, inclusively and comprehensively and which design elements must an ACP program have? Methods A Delphi study will be conducted with international ACP experts of all continents with a qualitative and a quantitative part. For the qualitative part (05–08.2025), the experts are asked to add missing aspects to the existing definitions (especially target groups, regional aspects and elements) in a survey (Software: Welphi). The results will be evaluated by thematic analysis using MAXQDA by a group of experts and used for a focus-group workshop at the ACP-i conference 2025. In the quantitative part (01–03.2026), these results will be translated into a second survey. Experts will be invited to rate and validate the results based on their cultural and professional understanding and, if necessary, provide reasons. The number of rounds will depend on the respective outcome. Results The results of the qualitative Delphi study thematic analysis will be presented and discussed at the congress. Discussion The results should enable us to come closer to a comprehensive, global definition of ACP including common core elements. This definition should define different target groups as well as regional aspects and necessary elements that make up an effective ACP program. Based on this definition, ACP programs can be better classified in ACP studies and clinical practice. Unique Contribution The previous ACP Delphi studies provided a step towards unifying select regional consensus definition for certain groups of persons and recommendations. A globally-shared consensus-based comprehensive definition and necessary design elements for ACP programs will support consistent application within multidisciplinary clinical practice, policies, research, and law. Implications This work will significantly impact how ACP interventions are understood and adapted across cultures and better understand how ACP is practiced and conveyed to persons and those important to them in the global context.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.072 | 0.056 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.005 | 0.004 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.009 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".