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      Advance Care Planning (ACP) vs. Advance Serious Illness Preparations and Planning (ASIPP)

      discussion
      Author(s): 1 , 2
      Publication date (Electronic):
      Journal: Healthcare
      Publisher: MDPI
      Keywords: end of life, serious illness, advance care planning, communication and decision-making, critical care

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          Abstract

          COVID-19 has highlighted the reality of an impending serious illness for many, particularly for older persons. Those faced with severe COVID-19 infection or other serious illness will be faced with decisions regarding admission to intensive care and use of mechanical ventilation. Past research has documented substantial medical errors regarding the use or non-use of life-sustaining treatments in older persons. While some experts advocate that advance care planning may be a solution to the problem, I argue that the prevailing understanding and current practice of advance care planning perpetuates the problem and results in patients not receiving optimal patient-centered care. Much of the problem centers on the framing of advance care planning around end of life care, the lack of use of decision support tools, and inadequate language that does not support shared decision-making. I posit that a new approach and new terminology is needed. Advance Serious Illness Preparations and Planning (ASIPP) consists of discrete steps using evidence-based tools to prepare people for future clinical decision-making in the context of shared decision-making and informed consent. Existing tools to support this approach have been developed and validated. Further dissemination of these tools is warranted.

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          Most cited references21

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          Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care.

          Judith Rietjens, Rebecca Sudore, Michael Connolly … (2017)
          Advance care planning (ACP) is increasingly implemented in oncology and beyond, but a definition of ACP and recommendations concerning its use are lacking. We used a formal Delphi consensus process to help develop a definition of ACP and provide recommendations for its application. Of the 109 experts (82 from Europe, 16 from North America, and 11 from Australia) who rated the ACP definitions and its 41 recommendations, agreement for each definition or recommendation was between 68-100%. ACP was defined as the ability to enable individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and health-care providers, and to record and review these preferences if appropriate. Recommendations included the adaptation of ACP based on the readiness of the individual; targeting ACP content as the individual's health condition worsens; and, using trained non-physician facilitators to support the ACP process. We present a list of outcome measures to enable the pooling and comparison of results of ACP studies. We believe that our recommendations can provide guidance for clinical practice, ACP policy, and research.
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            Advance directives and outcomes of surrogate decision making before death.

            Maria J Silveira, Scott Y H Kim, Kenneth M Langa (2010)
            Recent discussions about health care reform have raised questions regarding the value of advance directives. We used data from survey proxies in the Health and Retirement Study involving adults 60 years of age or older who had died between 2000 and 2006 to determine the prevalence of the need for decision making and lost decision-making capacity and to test the association between preferences documented in advance directives and outcomes of surrogate decision making. Of 3746 subjects, 42.5% required decision making, of whom 70.3% lacked decision-making capacity and 67.6% of those subjects, in turn, had advance directives. Subjects who had living wills were more likely to want limited care (92.7%) or comfort care (96.2%) than all care possible (1.9%); 83.2% of subjects who requested limited care and 97.1% of subjects who requested comfort care received care consistent with their preferences. Among the 10 subjects who requested all care possible, only 5 received it; however, subjects who requested all care possible were far more likely to receive aggressive care as compared with those who did not request it (adjusted odds ratio, 22.62; 95% confidence interval [CI], 4.45 to 115.00). Subjects with living wills were less likely to receive all care possible (adjusted odds ratio, 0.33; 95% CI, 0.19 to 0.56) than were subjects without living wills. Subjects who had assigned a durable power of attorney for health care were less likely to die in a hospital (adjusted odds ratio, 0.72; 95% CI, 0.55 to 0.93) or receive all care possible (adjusted odds ratio, 0.54; 95% CI, 0.34 to 0.86) than were subjects who had not assigned a durable power of attorney for health care. Between 2000 and 2006, many elderly Americans needed decision making near the end of life at a time when most lacked the capacity to make decisions. Patients who had prepared advance directives received care that was strongly associated with their preferences. These findings support the continued use of advance directives. 2010 Massachusetts Medical Society
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              Barriers to goals of care discussions with seriously ill hospitalized patients and their families: a multicenter survey of clinicians.

              John J You, James Downar, Robert Fowler … (2015)
              Seriously ill hospitalized patients have identified communication and decision making about goals of care as high priorities for quality improvement in end-of-life care. Interventions to improve care are more likely to succeed if tailored to existing barriers.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Healthcare (Basel)
                Journal ID (iso-abbrev): Healthcare (Basel)
                Journal ID (publisher-id): healthcare
                Title: Healthcare
                Publisher: MDPI
                ISSN (Electronic): 2227-9032
                Publication date (Electronic): 18 July 2020
                Publication date Collection: September 2020
                Volume: 8
                Issue: 3
                Electronic Location Identifier: 218
                Affiliations
                [1 ]Department of Critical Care Medicine, Queen’s University, Kingston, ON K7L 2V7, Canada; dkh2@ 123456queensu.ca ; Tel.: +1-(403)-915-5573
                [2 ]Clinical Evaluation Research Unit, Kingston Health Science Centre, Kingston, ON K7L 2V7, Canada
                Author information
                https://orcid.org/0000-0002-6440-4616
                Article
                Publisher ID: healthcare-08-00218
                DOI: 10.3390/healthcare8030218
                PMC ID: 7551637
                PubMed ID: 32708449
                SO-VID: 27f9c5c6-5adb-4dc1-8f3b-37fac67df948
                Copyright © © 2020 by the author.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 29 May 2020
                Date accepted : 10 July 2020
                Categories
                Subject: Commentary

                Keywords: end of life,serious illness,advance care planning,communication and decision-making,critical care
                Data availability:
                Keywords: end of life, serious illness, advance care planning, communication and decision-making, critical care

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