Advance care planning in serious illness: A narrative review Review
| Authors: | Rosa, W. E.; Izumi, S.; Sullivan, D. R.; Lakin, J.; Rosenberg, A. R.; Creutzfeldt, C. J.; Lafond, D.; Tjia, J.; Cotter, V.; Wallace, C.; Sloan, D. E.; Cruz-Oliver, D. M.; DeSanto-Madeya, S.; Bernacki, R.; Leblanc, T. W.; Epstein, A. S. |
| Review Title: | Advance care planning in serious illness: A narrative review |
| Abstract: | Context: Advance 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. Objective: To delineate ACP's potential benefits and missed opportunities and identify an evidence-informed, clinically relevant path ahead for ACP in serious illness. Methods: We 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. Results: Early 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. Conclusions: We 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. © 2022 American Academy of Hospice and Palliative Medicine |
| Keywords: | adult; treatment failure; review; drug efficacy; outcome assessment; clinical practice; palliative care; medical decision making; palliative therapy; patient care; systematic review; communication; patient-centered care; medline; interpersonal communication; clinical decision making; terminal care; patient preference; advance directives; shared decision making; narrative; documentation; search engine; living will; trust; end-of-life; advance care planning; security; serious illness; clinical decision-making; humans; human; male; female; goal-concordant care; grey literature |
| Journal Title: | Journal of Pain and Symptom Management |
| Volume: | 65 |
| Issue: | 1 |
| ISSN: | 0885-3924 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2023-01-01 |
| Start Page: | e63 |
| End Page: | e78 |
| Language: | English |
| DOI: | 10.1016/j.jpainsymman.2022.08.012 |
| PUBMED: | 36028176 |
| PROVIDER: | scopus |
| PMCID: | PMC9884468 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding author is MSK author William E. Rosa -- Export Date: 3 January 2023 -- Source: Scopus |
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