Advance Care Planning and End of Life Decision Making

2016 ◽  
Author(s):  
Lauren Jodi Van Scoy ◽  
Michael Green ◽  
Benjamin Levi
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Stages Of Change ◽  
Public Engagement ◽  
Care Planning ◽  
Institute Of Medicine ◽  
Life Issues ◽  
Advance Care ◽  
End Of Life Issues

Advance care planning (ACP) is defined by the Institute of Medicine as an iterative process that involves discussing end-of-life issues, clarifying relevant values and goals of care, and embodying preferences through written documents and medical orders. ACP is predicated on the principle of respect for autonomy, which recognizes an individual’s right to accept or decline medical therapies. With the development of medical technologies that can sustain life (including mere physiologic existence), effective ACP has become a critical yet underused process for patients, their families, and clinicians. This review discusses the emergence of ACP, promises and pitfalls of advance directives, and promising approaches, including ACP interventions and research, as well as a focus on public engagement and future directions. Figures show a timeline of important advances in ACP since 1990, key features of the comprehensive ACP process, the three core aspects or pillars for implementation of ACP, stages of change for ACP behaviors, and two commercially available end-of-life games. Tables list theoretical pros and cons of advance directives, ACP resources, examples of recent research studies on ACP interventions, types and examples of ACP resources, and public engagement campaigns.   This review contains 5 highly rendered figures, 5 tables, and 100 references.

Advance Care Planning and End of Life Decision Making

2016 ◽  
Author(s):  
Lauren Jodi Van Scoy ◽  
Michael Green ◽  
Benjamin Levi
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Stages Of Change ◽  
Public Engagement ◽  
Care Planning ◽  
Institute Of Medicine ◽  
Life Issues ◽  
Advance Care ◽  
End Of Life Issues

Advance care planning (ACP) is defined by the Institute of Medicine as an iterative process that involves discussing end-of-life issues, clarifying relevant values and goals of care, and embodying preferences through written documents and medical orders. ACP is predicated on the principle of respect for autonomy, which recognizes an individual’s right to accept or decline medical therapies. With the development of medical technologies that can sustain life (including mere physiologic existence), effective ACP has become a critical yet underused process for patients, their families, and clinicians. This review discusses the emergence of ACP, promises and pitfalls of advance directives, and promising approaches, including ACP interventions and research, as well as a focus on public engagement and future directions. Figures show a timeline of important advances in ACP since 1990, key features of the comprehensive ACP process, the three core aspects or pillars for implementation of ACP, stages of change for ACP behaviors, and two commercially available end-of-life games. Tables list theoretical pros and cons of advance directives, ACP resources, examples of recent research studies on ACP interventions, types and examples of ACP resources, and public engagement campaigns.   This review contains 5 highly rendered figures, 5 tables, and 100 references.

Advance Care Planning

2018 ◽  
Author(s):  
Lauren Jodi Van Scoy ◽  
Michael Green ◽  
Benjamin Levi
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Stages Of Change ◽  
Public Engagement ◽  
Care Planning ◽  
Institute Of Medicine ◽  
Life Issues ◽  
Advance Care ◽  
End Of Life Issues

Advance care planning (ACP) is defined by the Institute of Medicine as an iterative process that involves discussing end-of-life issues, clarifying relevant values and goals of care, and embodying preferences through written documents and medical orders. ACP is predicated on the principle of respect for autonomy, which recognizes an individual’s right to accept or decline medical therapies. With the development of medical technologies that can sustain life (including mere physiologic existence), effective ACP has become a critical yet underused process for patients, their families, and clinicians. This review discusses the emergence of ACP, promises and pitfalls of advance directives, and promising approaches, including ACP interventions and research, as well as a focus on public engagement and future directions. Figures show a timeline of important advances in ACP since 1990, key features of the comprehensive ACP process, the three core aspects or pillars for implementation of ACP, stages of change for ACP behaviors, and two commercially available end-of-life games. Tables list theoretical pros and cons of advance directives, ACP resources, examples of recent research studies on ACP interventions, types and examples of ACP resources, and public engagement campaigns.   This review contains 5 highly rendered figures, 5 tables, and 100 references.

Engaging new media to drive advance care planning.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 153-153
Author(s):  
Mary Frances Mulcahy ◽  
Daniel M. Gaitan ◽  
Randi Belisomo
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Advance Directive ◽  
Self Determination ◽  
Care Planning ◽  
Patient Centered ◽  
Life Issues ◽  
Advance Care ◽  
End Of Life Issues

153 Background: Though Congress enacted the Patient Self-Determination Act in 1991, only 18-36% of Americans have completed an advance directive. Less than half of severely ill patients had an advance directive in their medical record, only one in three with a chronic illness completed an advance directive, and studies suggest that two-thirds of physicians whose patients had advance directives were unaware of the existence of the documents. The Act required healthcare facilities to provide written information on rights to make treatment decisions and to make information available to patients who did not have an advance directive. There was a mandate directing HHS to conduct an awareness campaign about advance directives. The low acceptance of the directives demonstrates a failure to educate patients about their rights. Hypothesis: A patient-centered approach to end of life issues will generate better communication and result in greater acceptance of advance directives- achieving the goals of the Patient Self-Determination Act. Methods: A survey of 196 people showed that 67.7% felt that end of life issues were not covered enough in the media. We created a Newswire using WordPress and posted an average of three news stories weekly on topics pertaining to end of life. Posts were generated from existing media coverage and original reporting. The topics included culture, society, politics, healthcare, caregiving, law, advance care planning, hospice, and palliative care services. We tracked the number of views, the most viewed reports, monthly traffic and referral sources. We established Facebook, Twitter, and Pinterest accounts. We tracked followers, likes, re-tweets, pins, and shares. Results: From 8/2012 through 2/2013, the number of views increased from 566 to 2,452 with a peak of 3,809 in 11/2012. The most viewed day was 11/7/2012, the day following Election Day. The most viewed reports to date have been “Caregiver Discrimination Against LGBT Seniors,” “Psychedelic Drugs at the End of Life,” and “POLST Moving Forward in Illinois.” The referral sources in descending order are Facebook, Twitter, and Yahoo. Conclusions: We demonstrated that there is an interest in patient-centered topics pertaining to the end of life and that social media drives interest, education and conversation.

Engaging death: Narrative and constructed dialogue in Advance Care Planning discussions

2015 ◽  
Vol 11 (2) ◽  
pp. 153-165 ◽  
Author(s):  
Gabriella Modan ◽  
Seuli Bose Brill
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Cultural Barriers ◽  
Care Planning ◽  
Constructed Dialogue ◽  
Life Issues ◽  
Advance Care ◽  
End Of Life Issues ◽  
Death Narrative

Advance Care Planning (ACP) remains extremely low in the US, due to numerous institutional and cultural barriers and discomfort in discussing death. There is a need for guidance about how patient and healthcare providers can effectively engage in ACP discussion. Here we analyze the linguistic strategies that focus-group participants use when discussing ACP in detailed ways. Prevalent linguistic structures in effective ACP discussions were loved ones’ end-of-life narratives, hypothetical narratives, and constructed dialogue. In elucidating spontaneous, unprompted approaches to effective discussion of end-of-life issues, such research can help to dislodge communicative barriers to ACP so that more people are prepared to engage the process.

Advance Care Planning and End-of-Life Issues in Head and Neck Cancer

2018 ◽  
Vol 34 (1) ◽  
pp. 18-20 ◽  
Author(s):  
Frank E. Mott ◽  
Kelly C. Adams
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
End Of Life ◽  
Advance Care Planning ◽  
Neck Cancer ◽  
Care Planning ◽  
Life Issues ◽  
Advance Care ◽  
End Of Life Issues

Advance Care Planning and End of Life discussions are critical in all cancers but are often overlooked or delayed. Head and Neck Cancer patients have the added stigma of visible morbidity and negative quality of life issues. We present a case example and discussion of these issues in the Head and Neck cancer clinic.

Talking about sensitive topics during the advance care planning discussion: A peek into the black box

2015 ◽  
Vol 13 (6) ◽  
pp. 1669-1676 ◽  
Author(s):  
Pernille Andreassen ◽  
Mette Asbjørn Neergaard ◽  
Trine Brogaard ◽  
Marianne Hjorth Skorstengaard ◽  
Anders Bonde Jensen
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Special Focus ◽  
Care Planning ◽  
Life Care ◽  
Sensitive Topics ◽  
Life Issues ◽  
Advance Care ◽  
End Of Life Issues

AbstractObjective:Advance care planning (ACP) discussions are emphasized as a valuable way of improving communication about end-of-life care. Yet we have very little knowledge of what goes on during actual ACP discussions. The aim of our study was to explore how the sensitive topics of end-of-life decisions are addressed in concrete ACP discussions, with special focus on doctor–patient interactions.Method:Following a discourse-analysis approach, the study uses the concept of doctor and patient “voices” to analyze 10 directly observed and audiotaped ACP discussions among patients, relatives, and a physician, carried out in connection with a pilot study conducted in Denmark.Results:Previous studies of directly observed patient–physician discussions about end-of-life care show largely ineffective communication, where end-of-life issues are toned down by healthcare professionals, who also tend to dominate the discussions. In contrast, the observed ACP discussions in our study were successful in terms of addressing such sensitive issues as resuscitation and life-prolonging treatment. Our analysis shows that patients and relatives were encouraged to take the stage, to reflect, and to make informed choices. Patients actively explored different topics and asked questions about their current situation, but some also challenged the concept of ACP, especially the thought of being able to take control of end-of-life issues in advance.Significance of Results:Our analysis indicates that during discussions about sensitive end-of-life issues the healthcare professional will be able to pose and explore sensitive ACP questions in a straightforward manner, if the voices that express empathy and seek to empower the patient in different ways are emphasized.

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