The following is a summary of “Advance Care Planning in Serious Illness: A Narrative Review,” published in the January 2023 issue of Pain Management by Rosa, et al.
By soliciting patient preferences, advance care planning (ACP) aimed to enhance person-centered medical decision-making by soliciting patient preferences. Research had not shown any conclusive links between ACP and goal-concordant end-of-life care, which caused a legitimate scientific dispute on the usefulness of ACP. For a study, researchers sought to outline the potential advantages and unrealized potential of ACP and to suggest a therapeutically meaningful, evidence-based future course for ACP in severe disease.
Using a snowball search of PubMed, Medline, and Google Scholar, they carried out a narrative review combining the best available ACP empirical data, grey literature, and emerging scholarly debate (2000–2022). Their team’s multidisciplinary clinical and research skills in critical disease care impacted the findings.
Early ACP procedures were mostly based on required paperwork fulfillment, which could have missed the patients’ and surrogates’ holistic preferences. The outcomes for patients and clinicians from ACP models that prioritize critical illness conversation over documentation were encouraging. In an ideal world, ACP would result in goal-concordant treatment notwithstanding the unpredictable course of catastrophic disease. However, ACP may also provide patients with a false sense of confidence that their decisions would be respected and reviewed towards the end of life. Along with clinical practice, research, and policy suggestions, a framework that integrates ACP throughout serious diseases is presented.
They supported a balanced approach to ACP, considering empirical gaps as well as possible advantages and moral obligations (e.g., fostering clinician-patient trust and shared decision-making). They were in favor of prioritizing patient/surrogate-centered outcomes with stronger metrics that took into consideration the interpersonal clinician-patient factors that probably influenced ACP effectiveness and may help assess the data gathered from critical illness encounters.
Reference: jpsmjournal.com/article/S0885-3924(22)00866-1/fulltext
