Advance Care Planning During the COVID-19 Pandemic

Advanced Care Planning (ACP) in the early phase of COVID-19: A rapid review of the practice and policy lessons learned

“…Clinicians, patients and families used on-line platforms and telehealth technology to facilitate ACP. Several PRS and commentaries reported on uptake of outreach telehealth services and/or tool development (Bender et al, 2021; Biswas et al, 2020; DeFilippis et al, 2020; Galbadage et al, 2020; Ho & Neo, 2021; Kuntz et al, 2020; Osterman et al, 2021; Reja et al, 2020).…”

“…Numerous commentaries supported this finding (Ballantyne et al, 2020;Bender et al, 2021;Janwadkar & Bibler, 2020;Moore et al, 2020;Paladino et al, 2021;Raftery et al, 2020;Wallace et al, 2020). Commentators noted a lack of appropriate policies highlighting ACP's importance, a failure to prioritize it (Adams, 2020;Back et al, 2020;Bender et al, 2021;Chan et al, 2021;Ho & Neo, 2021), and either poor or overly-cumbersome documentation, as well as failure to remunerate appropriately e.g. with dedicated billing codes (Bender et al, 2021).…”

“…Nature of the disease. Both PRS and commentaries identified that the rapid evolution of COVID-19 and uncertain clinical outcomes impeded ACP (Adams, 2020;Back et al, 2020;Ballantyne et al, 2020;Bender et al, 2021;Galbadage et al, 2020;Heyland, 2020;Janssen et al, 2020;Raftery et al, 2020) A lack of prognostic clarity and varied treatment responses delayed ACP (Janssen et al, 2020). Consensus guidelines, by the European Respiratory Society, reported that patients were too ill or anxious to participate in ACP, exacerbated by family absence.…”

“…Several PRS highlighted that clinicians are time poor, with little time for lengthy discussions or to develop clinician-patient relationships and trust (Gilissen et al, 2020;Gupta et al, 2021;Liao et al, 2020;Salins et al, 2020;. Numerous commentaries supported this finding (Ballantyne et al, 2020;Bender et al, 2021;Janwadkar & Bibler, 2020;Moore et al, 2020;Paladino et al, 2021;Raftery et al, 2020;Wallace et al, 2020). Commentators noted a lack of appropriate policies highlighting ACP's importance, a failure to prioritize it (Adams, 2020;Back et al, 2020;Bender et al, 2021;Chan et al, 2021;Ho & Neo, 2021), and either poor or overly-cumbersome documentation, as well as failure to remunerate appropriately e.g.…”

Building a Comprehensive Advance Care Planning Approach in a Community Health System during COVID-19

“…Benefits of ACP include positive impacts on end-of-life care, decreased likelihood of futile treatments, and reduced medical costs [2,3]. Currently, the Centers for Medicare and Medicaid Services, through the Medicare Incentive Payment System (MIPS) and Alternative Payment Models (APM), include measures to track advance di-Health Educ Public Health 2021, 4:3 limited the ability to conduct family conversations for either shared decision making or to determine if a patient had already completed their AD [6]. Patients admitted for COVID-19 care, particularly those with underlying medical conditions, potentially faced rapid changes in health status which shortened the time to consider critical care or end-of-life (EOL) treatment options [7,8].…”