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Advance directives.

Linda L Emanuel¹

¹The Buehler Center on Aging, Health & Society, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. l-emanuel@northwestern.edu

Annual Review of Medicine

|August 25, 2007

Summary

Advance care planning empowers patients by documenting their wishes for medical care, even when unable to communicate. This process guides clinicians in making decisions aligned with patient values, ensuring personalized palliative and cure-oriented care.

Area of Science:

Medical Ethics
Patient-Centered Care
Healthcare Decision-Making

Background:

Patients desire control over medical decisions, particularly when incapacitated.
Clinicians need patient guidance for making decisions for non-participating individuals.

Purpose of the Study:

To outline the process and benefits of advance care planning.
To provide a framework for effective patient-clinician communication regarding future medical care.

Main Methods:

Utilizing validated worksheets for patients and families to express preferences.
Facilitating discussions on goals of care across various scenarios.
Integrating advance care planning into regular clinical encounters.

Main Results:

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Advance care planning yields clinically meaningful expressions of patient preferences.
Identifies patient-specific thresholds for shifting from cure-oriented to palliative care.
Enhances shared decision-making between patients, families, and clinicians.

Conclusions:

Advance care planning respects patient autonomy and improves care alignment.
Structured discussions and validated tools are crucial for effective advance care planning.
Integrating this process into routine care ensures patient wishes are honored.