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Advance Care Planning
The care planning umbrella: The evolution of advance care planning
Am Geriatr Soc, 2023
To evolve, we must reconceptualize ACP as a holistic process over the life course that includes both in-the-moment and advanced decisions at every life stage. We propose a new framework that reflects the updated focus on preparation for communication and medical decision-making and conceptualizes ACP as part of the continuum of care planning.
J Am Geriatr Soc, 2020
Scoping Review of high-quality ACP RCTs from the past decade (January 1, 2010, to March 3, 2020) show predominantly positive primary outcomes for all intervention types. Although some outcomes were mixed, outcomes concerning decreased surrogate distress were consistently positive. Recommendations for further research include tailoring interventions and outcomes for local contexts, to set appropriate expectations of ACP outcomes, and standardize across studies.
During COVID-19, Outpatient Advance Care Planning Is Imperative: We Need All Hands on Deck
J Am Geriatr Soc, 2020
In this letter to the editor we describe simple steps and simple scripts that all clinicians, regardless of discipline, can use to introduce advance care planning during the COVID-19 pandemic.
Outcomes that Define Successful Advance Care Planning: A Delphi Panel Consensus
J Pain Symptom Manage, 2018
A large, multidisciplinary Delphi panel developed an Organizing Framework and rated the importance of ACP outcome constructs. Top rated outcomes should be used to evaluate the success of ACP initiatives. More research is needed to create reliable and valid measurement tools for the highest rated outcomes, particularly “care consistent with goals.”
J Pain Symptom Manage, 2017
A multidisciplinary Delphi panel developed a consensus definition for ACP for adults that can be used to inform implementation and measurement of ACP clinical, research, and policy initiatives.
Advance Care Planning Beyond Advance Directives: Perspectives from Patients and Surrogates
J Pain Symptom Manage, 2013
Beyond ADs, patients and surrogates recommend several additional steps to prepare for medical decision making including using past experiences to identify values, verifying the surrogate understands their role, deciding whether to grant surrogates leeway, and informing other family and friends of one's wishes. Future ACP interventions should consider incorporating these additional ACP activities.
JAMA Intern Med, 2013
A commentary discussng why we should view knowledge and documentation of patients' preferences for medical treatment in the medical record through the lens of patient safety.
Lost in translation: the unintended consequences of advance directive law on clinical care
Ann Intern Med, 2011
Unintended negative consequences of advance directive legal restrictions may prevent all patients, and particularly vulnerable patients, from making and communicating their end-of-life wishes and having them honored. These restrictions have rendered advance directives less clinically useful. Recommendations include improving readability, allowing oral advance directives, and eliminating witness or notary requirements.
Redefining the "planning" in advance care planning: preparing for end-of-life decision making
Ann Intern Med, 2010
The purpose of this paper is to describe the problems with the traditional objective of advance care planning; provide an alternative objective that focuses on preparing patients and surrogates to make the best possible in-the-moment medical decisions; and outline practical steps that clinicians can take to achieve this new objective in the outpatient setting.
JAMA, 2009
A narrative essay reflecting on a personal story that changed the way the author, a geriatrician and palliative care physician, talked with patients and families about advance care planning and leeway for decision makers.