Advance Care Planning in Serious Illness: A Narrative Review

Area of Science:

• Medical Decision-Making
• Serious Illness Care
• End-of-Life Care

Background:

• Advance care planning (ACP) aims to support person-centered medical decisions by understanding patient preferences.
• Research has not consistently linked ACP to goal-concordant end-of-life care, sparking debate on its effectiveness.

Purpose of the Study:

• To explore the benefits and limitations of ACP.
• To identify an evidence-based approach for ACP in serious illness.

Main Methods:

• A narrative review of empirical data, grey literature, and scholarly discourse from 2000-2022.
• Utilized snowball searches in PubMed, Medline, and Google Scholar.
• Informed by interprofessional clinical and research expertise in serious illness.

Main Results:

• Early ACP models focused on documentation, often missing holistic patient preferences.
• ACP emphasizing serious illness communication shows better patient and clinician outcomes.
• ACP may offer false reassurance if not consistently revisited, impacting end-of-life care.

Conclusions:

• Advocates for a balanced ACP approach, acknowledging limitations and ethical benefits like trust and shared decision-making.
• Recommends prioritizing patient-centered outcomes and robust measures for ACP efficacy.
• Suggests an iterative framework for integrating ACP throughout serious illness care.