Advance Care Planning: Contemporary Issues and Future Directions

Area of Science:

• Gerontology
• Bioethics
• Health Policy

Background:

• Advance care planning (ACP) is crucial for aligning end-of-life care with patient and family preferences.
• ACP involves tools like living wills and durable power of attorney for health care (DPAHC) to document patient wishes.
• Existing disparities in ACP exist based on race and socioeconomic status in the United States.

Purpose of the Study:

• To analyze the strengths, weaknesses, and correlates of ACP in the U.S., focusing on disparities.
• To discuss public policies and community programs aimed at increasing ACP prevalence and efficacy.
• To evaluate Physician Orders for Life Sustaining Treatment (POLSTs) and Medicare's coverage of end-of-life consultations.

Main Methods:

• Review of existing literature on Advance Care Planning (ACP) in the United States.
• Analysis of public policies, community programs, and educational interventions related to end-of-life care.
• Examination of Physician Orders for Life Sustaining Treatment (POLSTs) and Medicare's role in facilitating ACP discussions.

Main Results:

• ACP's effectiveness is influenced by various factors, with notable racial and socioeconomic disparities.
• Policies like Medicare coverage for end-of-life consultations show potential but also present challenges.
• Community programs and educational initiatives are vital for improving ACP uptake and adherence.

Conclusions:

• There is a need for continued research to improve ACP's reach and effectiveness, particularly among underserved populations.
• International practices may offer insights into enhancing end-of-life care quality in the U.S.
• Addressing disparities and optimizing policy implementation are key to ensuring patient-centered end-of-life care.