Abstract
Dear Editor:
Italy was the first Western country to be faced with the COVID-19 pandemic. Since March 2020, several patients required concurrently life-sustaining therapies and invasive medical treatments. Owing to hospital visiting restrictions, having consultations with patients' relatives is complicated and, without advance directives, patients could receive treatments not aligned with their wishes and preferences. Indeed, the cultural sensitivity of planning end-of-life care is at its very beginning in Italy.
After many years of political and social debates, in December 2017, the first advance directive and care planning legislation was approved. Nevertheless, citizens' awareness of these issues is scarce, as is the integration of the advance care planning process into clinical routine. The latest data reported to the Italian parliament by the ministry of health indicated that advance directives have been completed by 62,030 people, ∼1.1% of Italian adult population. 1
However, during the last months, the COVID-19 pandemic solicited taking steps toward promoting an advance care planning culture. Italian National Bioethics Committee stressed the need of directives and care planning during the pandemic. 2 In March 2020, the Bioethics Commission of Florence Professional Order of Physicians approved a protocol for conducting advance care planning using a format to fill out directives. Likewise, several national and regional recommendations released by political institutions and medical associations in the last months have underlined the importance of conducting advance care planning with chronic patients. 3 This aim was also highlighted by palliative care interventions carried out across the country since the beginning of the spread of COVID-19. 4 Moreover, and interestingly, the literature describes an increase of the number of patients who have completed advance directives in the last months. 5 In this sense, the number of patients hospitalized in Tuscany Center Hospitals who requested advance care planning, especially those patients forced to come regularly into the hospital such as dialysis patients, increased since March 2020.
The take-home message is that the COVID-19 pandemic can be an opportunity for consolidate advance care planning in those countries where these interventions are not well known by patients and not yet regularly offered in the clinical routine. In addition, to overcome current social distancing restrictions, the use of telehealth can be valuable for advance care planning discussions.