Advance Care Planning: is quality end of life care really that simple?

Abstract

The routine implementation of Advance Care Planning (ACP) is now a prominent feature of policy directed at improving end of life care in Australia. However, while complex ACP interventions may modestly reduce medical care at the end of life and enable more people to die at home or outside of acute hospital settings, existing legal, organisational, cultural and conceptual barriers limit the implementation and utility of ACP. We suggest that meaningful improvements in end of life care will not result from the institutionalisation of ACP but from more significant changes to the design and delivery of care.

Reflection on stroke deaths and end‐of‐life stroke care

“…Given that stroke has a less than 50% 5‐year survival and 25–30% 5‐year recurrence rate, our data support the need to improve awareness of ACP in all incident stroke survivors. ACP not only recognises patient autonomy but also defines patient preferences in relation to intensive and life‐prolonging treatments when decision‐making capacity is lost and reduces costs of hospital care . However, successful implementation of ‘real‐world’ ACP has many barriers .…”

Advance care planning: a step in the right direction

“…In the April 2017 issue of the Internal Medicine Journal Komesaroff does the discussion around advance care planning (ACP) a service by critiquing autonomy as the philosophical foundation of ACP (of which advance care directives are an important part) and in raising the issue of cultural appropriateness of assuming autonomy as a guiding principle. However, the overall critique of ACP in this, and the article by Johnson et al ., is misguided.…”

Cluster-randomised trial of a nurse-led advance care planning session in patients with COPD and their loved ones

“…ACP-interventions are likely to improve patient outcomes, for example increased discussions about end-of-life care and improved patient satisfaction 7 8. However, there is much less evidence about the long-term impact of ACP9 and, for example, the influence of ACP on quality of death and dying.…”