Advance Care Planning in Serious Illness: A Narrative Review |
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| Affiliation: | 1. Department of Psychiatry and Behavioral Sciences (W.E.R.), Memorial Sloan Kettering Cancer Center, New York, New York;2. School of Nursing (S.I.), Oregon Health and Science University, Portland, Oregon;3. Division of Pulmonary and Critical Care Medicine (D.R.S.), School of Medicine, Oregon Health and Science University, Portland, Oregon;4. Department of Psychosocial Oncology and Palliative Care (J.L., R.B.), Dana-Farber Cancer Institute, Boston, Massachusetts;5. Division of Hematology-Oncology, Department of Pediatrics (A.R.R.), University of Washington School of Medicine, Seattle, Washington;6. Palliative Care and Resilience Lab (A.R.R.), Seattle Children''s Research Institute, Seattle, Washington;7. Department of Neurology (C.J.C.), University of Washington, Seattle, Washington;8. Pediatric and Neonatal Needs Advanced (PANDA) Education Consultants (D.L.);9. Chan Medical School, University of Massachusetts (J.T.), Worcester, Massachusetts;10. School of Nursing, Johns Hopkins University (V.C.), Baltimore, Maryland;11. School of Medicine, Johns Hopkins University (V.C.), Baltimore, Maryland;12. College for Public Health and Social Justice (C.W.), Saint Louis University, St. Louis, Missouri;13. Department of Health (D.E.S.), Behavior and Society, Johns Hopkins University, Baltimore, Maryland;14. Geriatric Medicine and Gerontology (D.M.C.O.), Beacham Center for Geriatric Medicine, Johns Hopkins Medicine, Baltimore, Maryland;15. Connell School of Nursing (S.D.M.), Boston College, Boston, Massachusetts;16. Department of Medicine (T.W.L.), Duke University School of Medicine, Durham, North Carolina;17. Department of Medicine (A.S.E.), Memorial Sloan Kettering Cancer Center, New York, New York;1. Department of Integrated Traditional Chinese and Western Medicine (L.Z., N.L.), West China Hospital, Sichuan University, Chengdu, Sichuan, China;2. Sichuan Second Chinese Medicine Hospital (Y.L., D.X., Y.D.), Chengdu, Sichuan, China;3. Chengdu University of Traditional Chinese Medicine (X.X., Y.S.), Chengdu, Sichuan, China;1. Department of Health Policy and Management (L.C.C., S.M.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, USA;2. Department of Pharmacy (E.G.S.), Massachusetts General Hospital, Boston, USA;3. Department of Pharmacy (J.M.W.), The Johns Hopkins Hospital, Baltimore, USA;1. Division of General Internal Medicine (S.F.), University of Colorado School of Medicine, Aurora, Colorado, USA;2. College of Nursing (M.I.), South Dakota State University, Rapid City, South Dakota, USA;3. Division of General Internal Medicine (R.K.S.), University of Washington School of Medicine, Seattle, Washington, USA;4. Division of Geriatric Medicine, Department of Medicine (K.S.J.), Duke University School of Medicine, Durham, North Carolina, USA;5. Geriatric Research (K.S.J.), Education, and Clinical Center (GRECC), Veterans Affairs Medical Center, Durham, North Carolina, USA;1. Department of Radiation Oncology (J.J.C.), University of San Francisco, San Francisco, California, USA;2. Northwestern Feinberg School of Medicine (C.S.R.), Chicago, Illinois, USA;3. Psychosocial Oncology and Palliative Care (A.N.N.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA;4. Department of Radiation Oncology (T.A.B., M.S.K.), Dana-Farber Cancer Institute/ Brigham and Women''s Cancer Center, Boston, Massachusetts, USA;5. Survey and Data Management Core (A.C.R.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA;6. Department of Radiation Oncology (A.B.C.), MD Anderson Cancer Center, Houston, Texas, USA;7. Department of Radiation Oncology (L.M.H.), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA;1. Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine (D.S., M.D.S., M.C.R.), New York, New York, USA;2. Department of Medicine (M.P., M.A.M.T., C.D.B.), Columbia University Irving Medical Center, New York, New York, USA;3. Department of Medicine (Y.A.), Brooklyn Campus of the VA NY Harbor Healthcare System, Brooklyn, New York, USA |
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| Abstract: | ContextAdvance care planning (ACP) intends to support person-centered medical decision-making by eliciting patient preferences. Research has not identified significant associations between ACP and goal-concordant end-of-life care, leading to justified scientific debate regarding ACP utility.ObjectiveTo delineate ACP's potential benefits and missed opportunities and identify an evidence-informed, clinically relevant path ahead for ACP in serious illness.MethodsWe conducted a narrative review merging the best available ACP empirical data, grey literature, and emergent scholarly discourse using a snowball search of PubMed, Medline, and Google Scholar (2000–2022). Findings were informed by our team's interprofessional clinical and research expertise in serious illness care.ResultsEarly ACP practices were largely tied to mandated document completion, potentially failing to capture the holistic preferences of patients and surrogates. ACP models focused on serious illness communication rather than documentation show promising patient and clinician results. Ideally, ACP would lead to goal-concordant care even amid the unpredictability of serious illness trajectories. But ACP might also provide a false sense of security that patients’ wishes will be honored and revisited at end-of-life. An iterative, ‘building block’ framework to integrate ACP throughout serious illness is provided alongside clinical practice, research, and policy recommendations.ConclusionsWe advocate a balanced approach to ACP, recognizing empirical deficits while acknowledging potential benefits and ethical imperatives (e.g., fostering clinician-patient trust and shared decision-making). We support prioritizing patient/surrogate-centered outcomes with more robust measures to account for interpersonal clinician-patient variables that likely inform ACP efficacy and may better evaluate information gleaned during serious illness encounters. |
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