Living Will and Advance Care Planning in Patients With Amyotrophic Lateral Sclerosis Admitted to Specialistic Home Palliative Care.

This article focuses on the implementation of Dichiarazione anticipata di trattamento (DAT), Italy’s legal form of "living wills," and advance care planning (ACP) among patients with amyotrophic lateral sclerosis (ALS) receiving specialized home palliative care. Despite the 2018 law enabling DAT, none of the 68 patients studied had completed a DAT prior to home care admission, and only one had an ACP before admission; during home care, 30.9% of patients provided ACP directives. The study highlights that ACP discussions typically occur only after initiating home palliative care, suggesting that home-based palliative services play a crucial role in facilitating end-of-life communication and decision-making in this population. Cultural, social, and systemic barriers contribute to the low uptake of DAT and ACP in Italy, underscoring the need for earlier and broader integration of advance care discussions supported by public awareness and coordinated healthcare efforts.