Should we still believe in advance care planning?

Abstract

This editorial comments on the article by https://doi.org/10.1111/jgs.17721. in this issue.

An age‐friendly population health dashboard geolocating by clinical and social determinant needs

“…It is also much lower than the reported ACP conversation and billing percentages in the literature varying from 13% to 74% 49,50 . Our low “Matters Most” results may be secondary to poor documentation, patient and clinician discomfort or lack of awareness regarding the value of ACP which itself has been questioned recently 51,52 …”

“…49,50 Our low "Matters Most" results may be secondary to poor documentation, patient and clinician discomfort or lack of awareness regarding the value of ACP which itself has been questioned recently. 51 did not allow confirmation that EMR medication lists were necessarily all being actively filled. Matters most definition included ACP billing which has been found to be low nationally, with only 15% of 53,926 practices being found to be billing for ACP.…”

“… 49 , 50 Our low “Matters Most” results may be secondary to poor documentation, patient and clinician discomfort or lack of awareness regarding the value of ACP which itself has been questioned recently. 51 , 52 …”

The care planning umbrella: The evolution of advance care planning

“…One initial goal was to curb unwanted LSTs and costs 1 . Yet, a focus solely on legal documentation of LST preferences has resulted in mixed data on goal‐concordant care and healthcare utilization 2–4 . Fortunately, the conceptualization of ACP continues to evolve, and is now widely recognized as a process of preparing patients (people) and surrogate decision‐makers for communication and medical decision‐making 5,6 .…”

Getting patients ready for “in the moment” decisions

“…The National Academy of Medicine defines patient‐centered as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” 1 In the context of serious illness and end‐of‐life care, ensuring that treatment recommendations align with patients' values and preferences is central to concepts of patient‐centered care. There has been recent contemporary debate around the effectiveness of advanced care planning conversations, and some have proposed a shift toward “in the moment” serious illness decision‐making 2 . However, Wong and colleagues 3 in this issue of the Journal of the American Geriatrics Society show that “in the moment decision making” was often initiated among this cohort of patients with advanced kidney disease when Veteran's “did not seem ready” and led to more reactive and practitioner‐driven decisions rather than patient‐centered decisions.…”