The following is a summary of “The Use of Templates for Documenting Advance Care Planning Conversations: A Descriptive Analysis,” published in the April 2023 issue of Pain Management by Schlichte, et al.
Advanced care planning (ACP) is important in providing patient-centered care, and professional societies have recommended using structured documentation templates for ACP conversations. However, the actual components of these conversations that clinicians document must be better understood. For a study, researchers sought to explore how clinicians document ACP conversations and identify which components of these discussions are documented.
A codebook was developed based on existing frameworks for ACP conversations and documentation. A total of 182 ACP notes from a hospital medicine quality improvement project conducted from November 2019 to April 2021 were included and assessed. The documentation was analyzed to identify the presence or absence of each component within the coding schema. Clinicians used three note types to document ACP: template (using only template prompts), template plus (adding additional text to the template), and free text only. ACP note components were analyzed by note type and author department.
The most common note type was template plus (58%), followed by free text (28%) and template (14%). The most frequently documented components across all note types were information about essential relationships with the patient (92%) and discussions of life-sustaining treatment preferences (87%). There was significant variability in the components documented across note types. Components related to treatment decisions and legal paperwork differed significantly between note types (P < 0.05). However, all note types rarely included components related to preferences for medical information, emotional state, or spiritual support.
The study initially explored ACP documentation and suggested that templates may influence the information documented after ACP conversations. Further research was needed to understand how documentation practices may impact patient-centered care and the quality of ACP conversations.