Advance Care Planning to Elicit and Respect Patient Values and Preferences

Advance care planning (ACP) is a patient-centered process to elicit patient and family goals and values that shape medical decision-making and form the basis for completing written advance directives. Advance directives such as healthcare power of attorney, surrogate decision-maker identification, and living wills are executed by the patient. These may be supplemented by provider orders such as resuscitation status (do not resuscitate/do not attempt resuscitation) and provider orders for life-sustaining treatment. Provider input into ACP is required as patients and families need information on prognosis and risks and benefits of interventions to make informed decisions. Because health states influence decisions for ongoing care, ACP is a process that requires revisiting wishes and goals via discussions at stages throughout a patient’s life. All healthcare systems through which a patient passes will need to be involved and cognizant of advance directives to ensure a patient’s wishes are honored. Dialysis units are an integral part of the healthcare system for end-stage kidney disease patients and need to be engaged in the ACP process. Consensus statements, guidelines, and tools exist to facilitate ACP in end-stage kidney disease and chronic kidney disease patients.