Advance Care Planning

Author: Linh Nguyen, MD

Overview

A patient's medical and end of life preferences are often not known. Predicting what treatment patients will want is complicated by the patient's age, the nature of the illness, the ability of medicine to sustain life, and the emotions families endure when their loved ones are sick and possibly dying.

Health care providers may provide assistance to a patient by explaining the following terms:

 

Key Points

AHRQ–funded research studies have shown the following:

Patients need more effective advance care planning.

Among patients 65 years and older, patient satisfaction is increased when physicians discuss advance care planning and directives.

Acceptance or refusal of invasive and noninvasive treatments under certain circumstances can predict what other choices the patient would make under the same or different circumstances.

Patients were likely to accept or refuse treatment based on how invasive they perceive treatment to be and how long the treatment is expected to last.

Patients were more likely to refuse treatment for a scenario with a worse prognosis.

AHRQ-funded research suggests a five-part process to structure discussion on end-of-life care:

  1. Initiate a guided discussion (see Family Meeting Gem and Pearl).
  2. Introduce the subject of advance care planning and offer information.
    • Patients should be encouraged to complete both advance directive and durable power of attorney.
  3. Prepare and complete advance care planning documents.
    • Advance care planning documents should contain specific instructions. AHRQ studies indicated that standard language contained in advanced directives often is not specific enough to be effective in directing care.
  4. Review the patient's preferences on a regular basis and update documentation.
  5. Apply the patient's desires to actual circumstances.

 

References

Advance Care Planning, Preferences for Care at the End of life.
http://www.ahrq.gov/research/findings/factsheets/aging/endliferia/index.html