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Advance Care Planning in Serious Illness: A Narrative Review.

Publication ,  Journal Article
Rosa, WE; Izumi, S; Sullivan, DR; Lakin, J; Rosenberg, AR; Creutzfeldt, CJ; Lafond, D; Tjia, J; Cotter, V; Wallace, C; Sloan, DE; Bernacki, R ...
Published in: J Pain Symptom Manage
January 2023

CONTEXT: Advance care planning (ACP) intends to support person-centered medical decision-making by eliciting patient preferences. Research has not identified significant associations between ACP and goal-concordant end-of-life care, leading to justified scientific debate regarding ACP utility. OBJECTIVE: To delineate ACP's potential benefits and missed opportunities and identify an evidence-informed, clinically relevant path ahead for ACP in serious illness. METHODS: We conducted a narrative review merging the best available ACP empirical data, grey literature, and emergent scholarly discourse using a snowball search of PubMed, Medline, and Google Scholar (2000-2022). Findings were informed by our team's interprofessional clinical and research expertise in serious illness care. RESULTS: Early ACP practices were largely tied to mandated document completion, potentially failing to capture the holistic preferences of patients and surrogates. ACP models focused on serious illness communication rather than documentation show promising patient and clinician results. Ideally, ACP would lead to goal-concordant care even amid the unpredictability of serious illness trajectories. But ACP might also provide a false sense of security that patients' wishes will be honored and revisited at end-of-life. An iterative, 'building block' framework to integrate ACP throughout serious illness is provided alongside clinical practice, research, and policy recommendations. CONCLUSIONS: We advocate a balanced approach to ACP, recognizing empirical deficits while acknowledging potential benefits and ethical imperatives (e.g., fostering clinician-patient trust and shared decision-making). We support prioritizing patient/surrogate-centered outcomes with more robust measures to account for interpersonal clinician-patient variables that likely inform ACP efficacy and may better evaluate information gleaned during serious illness encounters.

Duke Scholars

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Published In

J Pain Symptom Manage

DOI

EISSN

1873-6513

Publication Date

January 2023

Volume

65

Issue

1

Start / End Page

e63 / e78

Location

United States

Related Subject Headings

  • Terminal Care
  • Patient Preference
  • Humans
  • Communication
  • Clinical Decision-Making
  • Anesthesiology
  • Advance Care Planning
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
  • 11 Medical and Health Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Rosa, W. E., Izumi, S., Sullivan, D. R., Lakin, J., Rosenberg, A. R., Creutzfeldt, C. J., … Epstein, A. S. (2023). Advance Care Planning in Serious Illness: A Narrative Review. J Pain Symptom Manage, 65(1), e63–e78. https://doi.org/10.1016/j.jpainsymman.2022.08.012
Rosa, William E., Shigeko Izumi, Donald R. Sullivan, Joshua Lakin, Abby R. Rosenberg, Claire J. Creutzfeldt, Debbie Lafond, et al. “Advance Care Planning in Serious Illness: A Narrative Review.J Pain Symptom Manage 65, no. 1 (January 2023): e63–78. https://doi.org/10.1016/j.jpainsymman.2022.08.012.
Rosa WE, Izumi S, Sullivan DR, Lakin J, Rosenberg AR, Creutzfeldt CJ, et al. Advance Care Planning in Serious Illness: A Narrative Review. J Pain Symptom Manage. 2023 Jan;65(1):e63–78.
Rosa, William E., et al. “Advance Care Planning in Serious Illness: A Narrative Review.J Pain Symptom Manage, vol. 65, no. 1, Jan. 2023, pp. e63–78. Pubmed, doi:10.1016/j.jpainsymman.2022.08.012.
Rosa WE, Izumi S, Sullivan DR, Lakin J, Rosenberg AR, Creutzfeldt CJ, Lafond D, Tjia J, Cotter V, Wallace C, Sloan DE, Cruz-Oliver DM, DeSanto-Madeya S, Bernacki R, Leblanc TW, Epstein AS. Advance Care Planning in Serious Illness: A Narrative Review. J Pain Symptom Manage. 2023 Jan;65(1):e63–e78.
Journal cover image

Published In

J Pain Symptom Manage

DOI

EISSN

1873-6513

Publication Date

January 2023

Volume

65

Issue

1

Start / End Page

e63 / e78

Location

United States

Related Subject Headings

  • Terminal Care
  • Patient Preference
  • Humans
  • Communication
  • Clinical Decision-Making
  • Anesthesiology
  • Advance Care Planning
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
  • 11 Medical and Health Sciences