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Caught in a Loop with Advance Care Planning and Advance Directives: How to Move Forward?
Vyjeyanthi S Periyakoil1,2, Charles F von Gunten3, Robert Arnold4
1Department of Medicine, Stanford University, Palo Alto, California, USA.
Journal of Palliative Medicine
|March 1, 2022
Summary
Advance care planning (ACP) does not guarantee patients receive desired end-of-life care, despite decades of research. Future palliative care research must focus on symptom management and care models to ensure goal-concordant care.
Area of Science:
- Palliative Care
- Bioethics
- Health Services Research
Background:
- Advance care planning (ACP) and advance directives are intended to align end-of-life care with patient preferences.
- Despite extensive research over 30 years, ACP has not consistently ensured goal-concordant care for seriously ill patients.
- ACP is recognized as a component of palliative care, with some benefits like reduced surrogate grief identified.
Purpose of the Study:
- To evaluate the effectiveness of advance care planning in achieving goal-concordant end-of-life care.
- To identify limitations of current advance care planning research and implementation in healthcare systems.
- To advocate for a broader research agenda in palliative care beyond advance care planning.
Main Methods:
- Review of three decades of research on advance care planning and its outcomes.
- Analysis of the role of ACP initiatives within palliative care frameworks.
- Assessment of current healthcare system approaches to palliative care challenges.
Main Results:
- ACP completion does not reliably lead to patients receiving their desired end-of-life care.
- Solely implementing ACP initiatives is insufficient for addressing complex palliative care needs.
- Existing research suggests ACP alone does not guarantee goal-concordant care for the seriously ill.
Conclusions:
- Further research solely on ACP is unlikely to ensure goal-concordant care.
- Healthcare systems should not rely exclusively on ACP to solve palliative care issues.
- Future research should prioritize developing new tools for symptom management, care models, and systems ensuring goal-concordant care, considering finite resources.
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