Improving Medical-Legal Advance Care Planning

Deconstructing the Complexities of Advance Care Planning Outcomes: What Do We Know and Where Do We Go? A Scoping Review

“…In this context, a single ACP intervention would not be expected to positively affect all outcomes, which may be influenced by several other pillars. For example, a patientʼs ACP wishes may be moot if his/her surrogate is unprepared, community social norms do not support ACP, he/she lacks access to medical care, clinicians are untrained, health systems are not optimized to store and utilize ACP documents, and legislation is not optimized to help patients execute care plans 58,140,142 . Desired ACP outcomes may also be unattainable without standardized validated measures.…”

“…For health systems, electronic records and patient portals may provide additional opportunities to message patients, surrogates, and clinicians 150‐152 . Furthermore, policy and legislation changes may help to simplify ACP legal requirements and help make ACP billing easier and more widespread 140,142 . Although targeting all ACP stakeholders/pillars would be optimal, this is not feasible for many communities and healthcare systems.…”

“…For example, a patientʼs ACP wishes may be moot if his/her surrogate is unprepared, community social norms do not support ACP, he/she lacks access to medical care, clinicians are untrained, health systems are not optimized to store and utilize ACP documents, and legislation is not optimized to help patients execute care plans. 58,140,142 Desired ACP outcomes may also be unattainable without standardized validated measures. Each "pillar" may need its own tailored interventions and outcomes for which the intervention can reasonably be expected to affect, but this paradigm must be further explored.…”

“…execute care plans. 58,140,142 Desired ACP outcomes may also be unattainable without standardized validated measures. Each "pillar" may need its own tailored interventions and outcomes for which the intervention can reasonably be expected to affect, but this paradigm must be further explored.…”

“…[150][151][152] Furthermore, policy and legislation changes may help to simplify ACP legal requirements and help make ACP billing easier and more widespread. 140,142 Although targeting all ACP stakeholders/pillars would be optimal, this is not feasible for many communities and healthcare systems. The results of this review demonstrate that although we continue to expand clinician training and optimize health systems and policy, there may still be benefit in targeting one or more ACP stakeholders.…”