Research in health services & regions最新文献

{"title":"Factors associated with institutional delivery in south Asian countries: evidence from five recent demographic and health surveys.","authors":"Sifat Muntaha Soni, Md Ismail Hossain, Salma Akter, Shahjadi Ireen, Shuvongkar Sarkar, Shahanaj Parvin, Mansura Begum, Rebeka Sultana","doi":"10.1007/s43999-025-00071-3","DOIUrl":"https://doi.org/10.1007/s43999-025-00071-3","url":null,"abstract":"<p><strong>Background: </strong>Maternal and infant mortality is a major public health concern especially in South Asian nations. A significant proportion of mothers and infant died as a result of complications during birth. The delivery of healthcare facilities plays key role to lowering these mortality rates. The present study aimed to explore the prevalence of institutional delivery and its determinants in five South Asian countries.</p><p><strong>Methods: </strong>Data were extracted from five South Asian countries latest demographic and health survey data, including Afghanistan (2015), Bangladesh (2017-18), Nepal (2016), Myanmar (2015-16), and Pakistan (2017-18), all of which were pooled for the present study. A total of 38,975 women were included in this study after data handling. A multivariate binary logistic regression model was performed to identify the factors influencing institutional delivery.</p><p><strong>Results: </strong>More than half of all deliveries among the women were reported as occurring in a medical facility. The proportion of institutional deliveries was highest in Pakistan (68.80%), and lowest in Myanmar (40.60%). This study found that women who give birth at after 20 years' age had 1.25 times higher chance of getting healthy facility during delivery (OR 1.25, [1.19, 1.32]). The odds of institutional delivery were 2.18 times higher for highly educated women (OR 2.18, [1.89, 2.52]) and 2.88 times higher for rich women (OR 2.88, [2.70, 3.07]). The likelihood of getting his wife delivered in a hospital increased with the husband's education level. Women who accessed by any media showed 33% higher chance of getting healthy facility during child birth. Women who did not obtain ANC from a skilled provider had a reduced likelihood of selecting healthcare facility delivery by 71% (OR 0.29, [0.28, 0.31]) compared to women who did. Women who didn't take any health care decision by-self had 16% lower chance of getting institutional delivery facility than others. Most importantly, rural area in south Asian countries presented lower odds of receiving healthy facility during delivery (OR 0.63, [0.59, 0.68]).</p><p><strong>Conclusions: </strong>In conclusion, improving maternal health among South Asian countries requires addressing both individual and community-level factors. Women with higher education, better socioeconomic status, media exposure, and access to prenatal care are more likely to utilize medical services. Strengthening evidence-based health policies and ensuring strong leadership can enhance women's quality of life through better access to health care.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A closer look at regional differences in euthanasia practices in the Netherlands.","authors":"Wieke M R Ligtenberg, Theo A Boer, A Stef Groenewoud","doi":"10.1007/s43999-025-00069-x","DOIUrl":"10.1007/s43999-025-00069-x","url":null,"abstract":"<p><strong>Background: </strong>In research on practice variation, the body of knowledge on regional differences in the incidence of euthanasia is limited, and important questions have remained unanswered until now.</p><p><strong>Objective: </strong>This paper aims to gain insight in the differences between euthanasia practices in high-incidence regions and low-incidence regions, by looking at (potential differences in) a) patient characteristics; b) timelines and the process of euthanasia; c) the setting in which euthanasia takes place; and d) morally relevant themes.</p><p><strong>Methods: </strong>This explorative study uses a unique and fully anonymized dataset based on notes made by one of the authors (TAB) during a period of nine years in which he was an ethicist in a Dutch Euthanasia Review Committee. We analyzed these data using descriptive statistics and testing for statistical significance of differences in euthanasia practices in high-incidence regions and low-incidence regions.</p><p><strong>Results: </strong>Some significant differences were found between high and low-incidence regions. Compared to low-incidence regions, high-incidence regions were characterized by patients being older at time of death, a shorter time span between patients' first euthanasia request and their eventual death, patients more often having a GP as a consulting doctor, and euthanasia more frequently being the main dying means (as opposed to assisted suicide). The low incidence regions had somewhat younger patients, more patients with dementia, a longer life expectancy, more psychiatrists as consulting doctors, and more assisted suicides compared to the higher incidence regions.</p><p><strong>Conclusion: </strong>This study adds new insights to the existing literature on (regional differences in) end-of-life care, with a specific focus on euthanasia. Until now, euthanasia practices have mainly been studied at national levels. National data show significant differences between regions. The black box of local practices has not been opened before. Our results have implications for practice, as they may inform discussions on appropriate care at the end of life in general, and euthanasia in particular.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12287479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients potentially in need for palliative care in Germany-A regional small-area estimation based on death registry data.","authors":"Daniela Gesell, Farina Hodiamont, Claudia Bausewein, Eva Grill, Daniela Koller","doi":"10.1007/s43999-025-00070-4","DOIUrl":"10.1007/s43999-025-00070-4","url":null,"abstract":"<p><strong>Background: </strong>Demographic change and the increasing prevalence of chronic illnesses lead to a higher demand for palliative care. Currently, little is known about potential need for palliative care at a small-area level in Germany. However, this is crucial for the planning of services. We aimed to calculate the proportion of the population potentially in need of palliative care on a small-area level and to illustrate the nationwide variations.</p><p><strong>Methods: </strong>Retrospective cross-sectional study based on causes of death statistics in Germany. Causes of death of all adult deceased in Germany in 2022 were included. The potential need for palliative care was identified based on Murtagh et al. (2014) using ICD-10-codes. Geographic variation was analyzed on district level.</p><p><strong>Results: </strong>1,062,452 persons were documented in the causes of death statistics, of which 752,643 died with a potential palliative care need (70.8%). Overall mean age was 79.5 years (SD 12.7), 50.1% were female (n = 532,248). Most deaths were due to neoplasms (23,675; 22.6%) and cardiovascular diseases (230,338, 21.7%). The numbers of deceased with potential need per 100,000 inhabitants varied between districts from 578 to 1,438, with highest values in districts in Saxony, Thuringia, Saxony-Anhalt, and lowest in Bavaria and Baden-Wuerttemberg.</p><p><strong>Discussion: </strong>Our definition of potential palliative care need included both deaths due to oncological diseases, who commonly receive palliative care, and non-oncological conditions. The findings highlight the regional differences in potential palliative care need on small-area level and the importance of comprehensive healthcare planning adapted to the specific needs of individuals.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower ambulatory care availability and greater hospital capacity are associated with higher hospital case volumes.","authors":"Doreen Müller, Manas K Akmatov, Dominik Graf von Stillfried","doi":"10.1007/s43999-025-00066-0","DOIUrl":"10.1007/s43999-025-00066-0","url":null,"abstract":"<p><strong>Introduction: </strong>The German hospital reform introduces population-based planning to allocate hospital budgets, considering each hospital's role in meeting regional care needs. However, current hospital case numbers may reflect supply-side factors, such as physician density and socioeconomic disparities, rather than actual morbidity. Ambulatory care utilization inversely correlates with hospital usage, emphasizing the need to integrate ambulatory sector data into hospital planning. This study examines factors influencing hospital and office-based case numbers at the district level.</p><p><strong>Methods: </strong>Linking 2021 data from the Federal and State Statistical Offices, INKAR data and health insurance claims data in Germany at the district level, a multiple linear regression model assessed the association between case counts in hospitals or office-based practices per 10,000 residents and distance to the nearest general practitioner (GP), as well as hospital bed and GP density. The Global Moran's I as well as a geographically weighted regression (GWR) analysis were conducted to assess regional differences.</p><p><strong>Results: </strong>Multiple linear regression revealed that greater GP distance, fewer GPs and more hospital beds were linked to more hospital cases, while office-based cases rose with shorter GP distance. Global Moran's I confirmed spatial clustering, and GWR revealed heterogeneous effects of primary-care access on hospital admissions, whereas bed capacity uniformly increased hospital cases and shorter GP distances consistently predicted more office visits across Germany.</p><p><strong>Discussion: </strong>Our findings align with research showing supply-induced demand of hospital cases and emphasize the need for coordinated hospital and ambulatory care planning to improve access, reduce unnecessary hospital admissions, and optimize patient outcomes.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographical variations and potential low-value neuroimaging examinations in Norway from 2013 to 2022.","authors":"Ingrid Øfsti Brandsæter, Jan Porthun, Eivind Richter Andersen, Bjørn Morten Hofmann, Elin Kjelle","doi":"10.1007/s43999-025-00065-1","DOIUrl":"10.1007/s43999-025-00065-1","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the variations in the use of neuroimaging over time and across geographical regions and to investigate the use of two potential low-value neuroimaging examinations for all imaging in an entire country (Norway), including both inpatient and outpatient services from 2013 to 2022.</p><p><strong>Method and methods: </strong>Data on neuroimaging for outpatients was collected from the Norwegian Health Economics Administration, and inpatient data were collected from individual Hospital Trusts (HT) in Norway. The data were analysed using descriptive statistics.</p><p><strong>Results: </strong>On average, 413,303 (786 per 10,000 inhabitants) neuroimaging examinations were performed annually in Norway. Overall, the use increased by 16% during the study period. Substantial geographical variations were found both in general and for the two potential low-value neuroimaging examinations; Brain Magnetic Resonance Imaging (MRI) and Head Computed Tomography (CT). For general neuroimaging, the HT with the highest use performed twice as many examinations as the HT with the lowest use per inhabitant. For the potential low-value neuroimaging examinations, the HTs with the highest use performed two and three times as many examinations as the HTs with the lowest use per inhabitant.</p><p><strong>Conclusion: </strong>There was temporal and geographical variation in the general use of neuroimaging and the use of the two potential low-value examinations, Brain MRI and Head CT. In Norway, the estimated annual cost of low-value neuroimaging examinations is about EUR 4.0 million. Reducing the use of low-value imaging would free up resources for examinations of high value.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal healthcare utilisation, women empowerment, and delivery care: geographical variations in India.","authors":"Prachi Verma, Ningombam Sanjib Meitei, Sanjram Premjit Khanganba","doi":"10.1007/s43999-025-00063-3","DOIUrl":"https://doi.org/10.1007/s43999-025-00063-3","url":null,"abstract":"<p><p>This study utilises the National Family Health Survey- 5 (NHFS-5) data to compare performance in three key indicators called pillars of maternal health, namely-Maternal Healthcare Utilisation (MHU), Women Empowerment (WE), and Delivery Care (DC) across six zones of India: East, West, North, South, Central, and Northeast. It employs the Statistical Performance Index (SPI) by the World Bank to calculate zonal scores for the pillars. Univariate and multivariate statistical analyses reveal significant zonal disparities in all the three pillars (MHU: p < .001, WE: p < .002, and DC: p < .010). Northeast zone has the lowest MHU score (M = 56.52) and the second-lowest DC score (M = 46.60), despite having the second highest WE score (M = 66.37), only behind the South zone which leads in all pillars (MHU; M = 80.38, WE; M = 69.21, and DC; M = 57.60). WE accounts for only a small part of the variability in MHU (R²= .166), indicating that WE alone is insufficient to improve MHU outcomes. This study emphasises the need for further exploration of factors such as difficult terrains and low hospital density, especially in the Northeast zone.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing health equity in Nova Scotia by exploring gaps in healthcare delivery: a mixed methods protocol.","authors":"Jennifer Lane, Neda Alizadeh, Christine Cassidy, Neil Forbes, Holly McCulloch, Katrina Jarvis, Helen Wong, Courtney Pennell, Lori Wozney, Kris Lane, Brittany Barber, Kelly Lackie, Bukola Oladimeji, S M Kawser Zafor Prince, Drew Burchell, Noah Doucette, Cyril O'Brien, Wyatt LeRoy, Kendra MacEachern, Elizabeth Obeng Nkrumah, Joshua Edward, Arezoo Mojbafan, Megan White, Tatianna Beresford, Janet Curran, JianLi Wang, Marilyn Macdonald","doi":"10.1007/s43999-025-00062-4","DOIUrl":"https://doi.org/10.1007/s43999-025-00062-4","url":null,"abstract":"<p><p>Population health issues are addressed by various regional initiatives in the Canadian province of Nova Scotia (NS). A need for research on the root causes of health inequities suggests there may be a lack of evidence to inform current initiatives within the region. To address this gap, a three-phase sequential mixed methods study called Advancing Health Equity in NS by Exploring Gaps in Healthcare Delivery will operationalize Intersectionality Theory and employ an integrated knowledge translation approach to identify and explore gaps in health service delivery. This will promote a better understanding of how to improve the integration of health equity in health service and delivery systems and thus population health and well-being. The following objectives will be addressed in each phase: 1) create an inventory of NS-relevant knowledge that relates to health equity, 2) examine the integration of health equity in NS health service and delivery systems using a context-specific health equity lens, and 3) mobilize knowledge on how gaps in service delivery can be addressed to improve the integration of health equity and better meet the needs of people living in NS. The study results from this protocol will be used to integrate health equity in NS health service and delivery systems, enhancing the quality of care for populations rendered vulnerable by structural inequalities, and working to prevent negative impacts to health and wellbeing.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-specific and regional differences in the prevalence of diagnosed autoimmune diseases in Germany, 2022.","authors":"Manas K Akmatov, Claudia Kohring, Frank Pessler, Jakob Holstiege","doi":"10.1007/s43999-025-00061-5","DOIUrl":"10.1007/s43999-025-00061-5","url":null,"abstract":"<p><strong>Background: </strong>Research on the epidemiology of autoimmune diseases is impeded due to the rarity of most autoimmune diseases. We aimed to assess the prevalence of diagnosed autoimmune diseases in Germany and examine their sex-specific and regional differences.</p><p><strong>Methods: </strong>A cross-sectional study using the nationwide ambulatory claims data of females and males of any age with statutory health insurance from 2022 was designed (N = 73,241,305). Autoimmune diseases were identified by diagnostic codes of the International Classification of Diseases and Related Health Problems, 10th Revision, German Modification (ICD-10-GM). Regional differences were examined at the level of urban and rural districts (N = 401). To control for demographic differences across districts we applied the direct standardization method to calculate sex- and age-standardized prevalences with the German population in 2022 used as a standard population. Furthermore, we calculated prevalence ratios (PR) and 99% confidence intervals (99% CI) to examine sex differences.</p><p><strong>Results: </strong>Of 73,241,305 insurees (median age, 45; interquartile range, 26-63 years), 6,307,120 had at least one (any) autoimmune disease in 2022, corresponding to a crude prevalence of 8.61% (99% CI: 8.60-8.62%). Of all individuals with autoimmune diseases, 67% were females. The prevalence of single autoimmune diseases varied between 0.008% (pemphigus) and 2.3% (autoimmune thyroiditis). Other autoimmune diseases with a high prevalence were psoriasis (1.9%), rheumatoid arthritis (1.4%), and type 1 diabetes (0.75%). The prevalence was higher in females than males for 25 of the 31 autoimmune diseases with the highest PR observed for autoimmune thyroiditis (PR 5.92; 99% CI: 5.88-5.95), primary biliary cirrhosis (5.60; 5.36-5.84) and systemic lupus erythematosus (5.15; 4.97-5.36). Males were more likely to be diagnosed than females with type 1 diabetes (1.37; 1.36-1.39), ankylosing spondylitis (1.40; 1.39-1.43) and Guillain-Barré syndrome (1.31; 1.27-1.37). The only autoimmune disease without sex difference was myasthenia gravis (1.00; 0.97-1.03). At district level the age- and sex-standardized prevalence of at least one (any) autoimmune disease differed by a factor of nearly 2 between 5.91% and 11.62%. In general, the prevalence was higher in East (former GDR) than West (former FRG) Germany.</p><p><strong>Conclusion: </strong>Although most autoimmune diseases were rare, when considered as a whole, autoimmune diseases turned out to be more common than previously assumed, with one out of 12 individuals affected in Germany.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice variation in induction of labour: women's role in the decision-making process.","authors":"Anne E M Brabers, Tamar M Van Haaren-Ten Haken, Judit K J Keulen, Pien M Offerhaus, Marianne J Nieuwenhuijze, Judith D de Jong","doi":"10.1007/s43999-025-00059-z","DOIUrl":"10.1007/s43999-025-00059-z","url":null,"abstract":"<p><p>In the Netherlands, percentages of induction of labour (IOL) range from 14.3 to 41.1% in regional maternity care networks (MCNs). In this study, we focus on women's contribution in explaining this variation in range. We examine if different factors at the level of the individual woman (micro) and the level of the woman's social context (meso) are related to decision-making on IOL, and the variation. We used an online questionnaire inviting women counselled for IOL (n = 180, response rate 40%) from six different MCNs, three with a high and three with a low percentage of IOL. Factors included are, for example, attitude towards birth, reason for IOL, and social norms. Descriptive statistics and regression analyses were performed to examine the relation between the included factors and the intended decision on IOL. Our results show that only the factor women's attitude towards birth is related to the intended decision on IOL. The more women believe that birth is a medical process, the higher the odds that the intended decision is to induce labour. This may contribute to variation in IOL between individual women, but appears to contribute less to variation in IOL between MCNs. This is because the percentages of women with an intended decision for IOL do not differ within MCNs with a low or high percentage of IOL. A next step in explaining practice variation, is to examine mechanisms at the level of the individual healthcare provider (micro) and the MCN (meso).</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The instrumental value of advance directives: lesson learned from the COVID-19 pandemic for policymaking.","authors":"Elisabeth Stock, Christian H Nickel, Bernice S Elger, Andrea Martani","doi":"10.1007/s43999-025-00060-6","DOIUrl":"10.1007/s43999-025-00060-6","url":null,"abstract":"<p><p>Open conversations between patients and healthcare professionals (HCP) are required to evaluate which treatments are reasonable for the individual case, especially towards the end of life. Advance Care Planning (ACP), which often results in drafting an Advance Directive (AD), is a useful tool to help with decisions in these circumstances, but the rate of AD completion remains low. During the COVID-19 pandemic, ACP and AD gained popularity due to the alleged advantage that they could facilitate resource allocation, to the benefit of public health. In this article, which presents a theoretical reflection grounded in scientific evidence, we underline an even stronger ethical argument to support the implementation of AD in end-of-life care (eol-C) i.e. the instrumental value at the individual level. We show, with particular reference to lessons learned from the COVID-19 pandemic, that AD are instrumentally valuable in that they: (1) allow to thematise death; (2) ensure that overtreatment is avoided; (3) enable to better respect the wish of people to die at their preferred place; (4) help revive the \"lost skill\" of prognostication. We thus conclude that these arguments speak for promoting the territorially uniform implementation and accessibility of high-quality AD in care.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}