The Case for Advance Care Planning. Advance care planning is a series of conversations that a patient and you, their care provider, have about end of life wishes. These can be captured into an advance care plan, that may include both a selection of a health care agent or surrogate, and a living will with specific guidance on desires for interventions and level of care. These two together can form an Advanced Directive. This is a legal document that has no expiration date. It is intended to provide guidance to the named or default healthcare agent on wishes of the individual for their care. Once legally completed, it is transportable across states
Why is counseling your patient on Advance Care Planning so important? Data are compelling that our population is aging, and the types and trajectories of death are changing. Whereas relatively acute episodes of untreatable disease or trauma used to be the norm which led to shortened and abrupt trajectory to death, chronic diseases, particularly cardiovascular and pulmonary disease, have become the predominant causes of death. Seven out of ten Americans die of a chronic disease. These common trajectory now is a prolonged, downhill course with occasional decompensations and recovery until a decompensation happens from which there isn’t recovery. Patients now live longer with serious illness and disability, making their life and dying decisions so important not only for the quality of their remaining lives, but also for more rationale use of healthcare resources. Healthcare costs skyrocket in the last two years of life, accounting for almost 30% of healthcare expenditures. With the aging of the population, this is only going to increase. Although the Medicare hospice benefit provides for care in the last six months of life, the average duration in hospice in only a week. A California Health Care Foundation survey found that only 20% of Californians have talked about their end of life wishes with their doctors.
Advance care planning increases patient satisfaction and fulfillment of their healthcare wishes more often but also reduces hospitalizations, ED visits and costs in the last two years of life. Advance care planning is a win for patients, a win for providers, and a win for healthcare systems.
Next in Series: Advanced Directives and Selection of a Surrogate
Written by: Scott Endsley MD, Associate Medical Director, Quality