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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Palliative Care 1/2014

Intervention thresholds: a conceptual frame for advance care planning choices

BMC Palliative Care > Ausgabe 1/2014
Karen G Scandrett, Brian Joyce, Linda Emanuel
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-684X-13-21) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

KS designed the study, analyzed the data and wrote the manuscript. BJ conducted data collection, and assisted with both data analysis and manuscript preparation. LE designed the original survey instrument, supervised the study, and assisted with data analysis. All the authors approve this manuscript and agree to its submission.



Advance care planning (ACP) provides for decisions in the event of decisional incapacity. Determining ahead of time what a person may want is challenging and limits the utility of ACP. We present empirical evidence for a new approach to ACP: the individual’s “intervention threshold.” The intervention threshold is intuitively understood by clinicians and lay people, but has not been thoroughly described, measured, or analyzed.


Using a mixed-methods approach to address the concept of the intervention thresholds, we recruited 52 subjects from a population of chronically ill outpatients for structured telephone interviews assessing knowledge, attitudes, and prior ACP activities. Respondents were presented with 11 interventions for each of four medical scenarios. For each scenario, they were asked whether they would accept each intervention. Data was evaluated by descriptive statistics and chi-squared statistics.


Complete data were obtained from 52 patients, mean age of 64.5, 34.6% of whom were male. Only 17.3% reported prior ACP discussion with a physician. Rates of accepting and refusing interventions varied by scenario (p < 0.0001) and intervention intensity (p < 0.0001).


These data provide evidence that people display transitions between wanting or not wanting interventions based on scenarios. Further research is needed to determine effective ways to identify, measure, and represent the components of an individual’s intervention threshold in order to facilitate informed decision making during future incapacity.
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