Giovanna Ricci, Filippo Gibelli, Giulio Nittari, Silvano Leone, Anna Maria Caraffa, Ascanio Sirignano
Although law 219 of 2017 was the first end-of-life legislation in Italy, it still struggles to take root and be fully implemented more than two years since entering into force. Our work focuses on the preliminarily analysis of this legislation and then quantifies the number of advance care planning (ACP) dispositions filed in the municipal offices of the territory examined. We focus on three provinces of central Italy, Ascoli Piceno, Fermo and Teramo, to verify the deposition of ACP dispositions. Then, we analyze how many dispositions for advance care planning are deposited in the municipal registers. The research reveals critical barriers to the full implementation of this law. Only a small percentage of the 118 municipalities monitored have opened a municipal register to deposit ACP dispositions. There are also shortcomings in the establishment of a national database for the depositing of ACP dispositions, there has been a lack of inclusion of ACP dispositions in electronic health records, and hospitals still do not have real-time access to documents that disposers have made on their end of life plans.