[Going to the hospital or not? Limitations of the interpretation of treatment preferences in acute situations at home].

When talking about 'advance care planning' (ACP), people regularly state that they do not want to go to the hospital any more. There are several reasons why this wish may be unclear in acute situations: preferred treatment is not always available or discussed, there may be different reasons for the 'no more hospital' statement and the emergency department is often insufficiently prepared for carrying out limited evaluations or treatments. To provide appropriate care, we recommend to (a) discuss the limitations of ACP, (b) evaluate preferences in the current context, (c) improve communication between primary and secondary care and to consider alternative options, (d) regularly evaluate current policies and (e) invest in local initiatives to prevent admission or long-term admission or to enable people to stay home. Treatment preferences, supported by earlier ACP discussions, always develop through the relationship between physicians and patients in specific situations.