Palliative Medicine and Hospice Care · Vol. 6, No. 2 · 2020 · pp. e3 · e-ISSN 2377-8393

Promoting Advance Directive Discussions

James S. Powers

Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville,Tennessee 37232, USA; Vanderbilt University School of Medicine, Nashville,Tennessee, USAUnited States

DOI: https://doi.org/10.17140/pmhcoj-6-e010 · Published 2020-12-01 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2020 The Author(s)

Also available as PDF (figures and tables appear in the PDF).

Abstract

Advance care planning (ACP) which includes a discussion of goals of care and preferences about future care improves patient-centered care at the end-of-life. However, completion of ACP remains low with an estimated 36.7% of adults having com-pleted an advance directive in the United States1 and this number is lower in many other societies worldwide.

Discussions

1,2* James S. Powers, MD1,2*

1Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville,Tennessee 37232, USA

2Vanderbilt University School of Medicine, Nashville,Tennessee, USA

* *Corresponding author

James S. Powers, MD

Clinical Associate Director,Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center,Vanderbilt University School of

Medicine, Nashville,Tennessee 37232, USA;Tel. 615-343-6726; Fax. 615-322-1754; E-mail: James.powers@vanderbilt.edu

Article information

nd th st Received: November 22 , 2020; Accepted: November 25 , 2020; Published: December 1 , 2020

Cite this article

Powers JS. Promoting advance directive discussions. Palliat Med Hosp Care Open J. 2020; 6(2): e3. doi: 10.17140/PMHCOJ-6-e010

dvance care planning (ACP) which includes a discussion of may also lead to discussions with trusted healthcare providers and

goals of care and preferences about future care improves improved documentation in healthcare records. Large employers

A

patient-centered care at the end-of-life. However, completion of especially have the potential to reach numerous individuals and to

ACP remains low with an estimated 36.7% of adults having comhelp normalize the conversation on end-of-life care. This can ben-

pleted an advance directive in the United States1 and this number efit all of society, demystify and reduce the stigma related to ACP,

is lower in many other societies worldwide. Social stigma, personal and help avoid emergency ACP.

difficulty accepting the finality of life, and agism all contribute to

avoidance of discussions of end-of-life care. The topic of ACP

References

  1. Yadav KN, Gabler NB, Cooney E, Kent S, Kim J, Herbst N, et trusted healthcare professionals. In the absence of ACP urgent disal. Approximately one in three US adults completes any type of cussions necessitated by medical crises, while necessary, are often advance directive for end-of-life care. Health Aff (Millwood). 2017; traumatic and may limit involvement of the affected individual and 36(7): 1244-1251. doi: 10.1377/hlthaff.2017.0175 place increased burden on the surrogate decision maker https://doi.org/10.1377/hlthaff.2017.0175
  2. PowersJSAbrahamL. Outpatient–focused advance care plan-Many models to promote ACP are in common use, inning: Telehealth consultation for geriatric primary care patients. cluding education on the importance of advance directives for pri-Palliat Med Hosp Care Open J. 2019; 5(2): 23-26. doi: 10.17140/PMmary care providers, clinical prompting at the point of patient care, HCOJ-5-133 embedding palliative care trained clinicians in chronic disease and oncology clinics, and inquiring about the presence of advance di-10.17140/pmmary https://doi.org/10.17140/pmmary
  3. GuptaAJinGReichAPrigersonHGLadinKKimD. It is time to reimagine the approach to ACP and create Association of billed advance care planning with end-of-life care a cultural shift in society to enhance the discourse on end-of-life intensity for 2017 medicare decedents. J Am Geriatr Soc. 2020. doi: care, taking a public health approach.5 One model may be to in- 10.1111/jgs.16683 tegrate consideration of ACP into regular benefits “check-ups” among employed individuals during enrollment and open season10.1111/jgs.16683 https://doi.org/10.1111/jgs.16683
  4. AbelJKellehearA. Palliative care reimagined: A needed shift. periods. Enhanced discussion and completion of advance direc-BMJ Support Palliat Care. 2016; 6(1): 21-26. doi: 10.1136/bmjsptives among employed individuals may encourage intergenerational care-2015-001009 conversations about end-of-life care with other family members. It Submit your article to this journal | https://openventio.org/submit-manuscript/ cc Copyright 2020 by Powers JS. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which10.1136/bmjsptives https://doi.org/10.1136/bmjsptives