What’s Wrong With Advance Care Planning?

Abstract

Advance care planning (ACP) has emerged during the last 30 years as a potential response to the problem of low-value end-of-life care. The assumption that ACP will result in goal-concordant end-of-life care led to widespread public initiatives promoting its use, physician reimbursement for ACP discussions, and use as a quality measure by the Centers for Medicare & Medicaid Services, commercial payers, and others. However, the scientific data do not support this assumption. ACP does not improve end-of-life care, nor does its documentation serve as a reliable and valid quality indicator of an end-of-life discussion.

Exploring Web-Based Twitter Conversations Surrounding National Healthcare Decisions Day and Advance Care Planning From a Sociocultural Perspective: Computational Mixed Methods Analysis

“…Key to the diffusion of information and the creation of communities on Twitter is the use of hashtags, which could serve to unify discourse and induce a sense of support and belonging [ 26 , 27 ]. Coupling this with recent calls to reconsider approaches to ACP [ 9 , 28 - 30 ], we extend this work as this study situates Twitter as a social media tool and relevant NHDD hashtags as a mechanism to engage in conversations related to ACP.…”

“…It appears that education and awareness may not be the biggest barriers to ACP; people are aware that it exists, but there may be little action toward identifying specific wishes for care along the EOL continuum from diagnosis through death [ 17 ]. Morrison et al [ 30 ] argued that unless the health care system supports goal-centered care and provides resources to follow through with physician-patient conversations and consequential delivery of care, ACP outcomes will fall short of the intended goal; that is, providing the care at EOL that the patient wants. We see this conversation taking place on a global scale, as internationally, there are efforts to bring value back into the EOL [ 5 ].…”

Challenges Experienced by Italian Nursing Home Staff in End-of-Life Conversations with Family Caregivers during COVID-19 Pandemic: A Qualitative Descriptive Study

“…However, it was often not easy to elicit FCs' care preferences since most FCs still experienced death as a taboo [53]. Moreover, as previously highlighted [54,55], FCs' care preferences were rarely static and were influenced by their relative's health status in addition to a sense of obligation and responsibilities associated with the social role expectations; FCs were often driven by a filial duty to leave nothing undone, which was paired with the misbelief that opting for a comfort-oriented approach meant abandonment of the relative. Lack of time, poor or fragmented communication among HCPs, and further increase in the known nursing staff turnover and shortages during the pandemic after extra nurses were called into hospitals to deal with the care pressure from COVID-19 patients were confirmed to be barriers to initiating and sustaining end-of-life conversations [16].…”

Efficacy of a Communication-Priming Intervention on Documented Goals-of-Care Discussions in Hospitalized Patients With Serious Illness

“…High-quality goals-of-care communication among clinicians, patients, and surrogate decision-makers, and documentation of such discussions, may be important to providing patients with goal-concordant, patient-centered care. 1 , 2 , 3 , 4 , 5 Although there is debate about the value of advance care planning for healthy adults, 6 , 7 there is more agreement about the importance of goals-of-care discussions with seriously ill patients facing important treatment decisions. 2 We define goals-of-care discussions as discussion of the “overarching aims of medical care for a patient” 8 used to inform current or near-future treatment decisions.…”