Advance Care Planning: What, When, and How?

Abstract

Advance care planning (ACP) is a fundamental part of the patient-provider relationship. It is a process that evaluates a person's values and determines preferences for care in various clinical scenarios, based on personal goals and expectations. ACP has two main goals: 1) identifying the surrogate decision maker; and 2) establishing the patient's goals of care for treatments or procedures which align with their wishes. ACP provides an opportunity to help patients and their families to prepare, on their own terms, for the changes brought by serious or progressive illness. This fosters a collaborative, therapeutic relationship in planning for the future.1 When addressing goals of care, it is essential to evaluate the perceived burden of certain procedures or life conditions such as depending on others for activities of daily living (ADLs) or living in a long-term care facility. As providers, we use patient history, laboratory data, exam findings, pathology reports, imaging studies, and more in making medical decisions for patients and recommending a plan of care. ACP can provide additional valuable information to guide patient-centered medical management. In this article, we will discuss the current state of goals-of-care conversations, compare the different ACP documents currently available, and provide guidance to providers on how to engage in these conversations. This includes addressing patient's values, wishes, and fears, without diminishing their sense of hope.