The Common Sense Guide to Improving Palliative Care > Advance Care Planning > 3.1 Chapter Overview

Sick To Death book cover This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

Advance Care Planning: Chapter Overview

Many factors influence treatment decisions near the end of life: How old is the patient? How sick? Will treatment enhance life or mostly prolong suffering? What does the patient want? What does the family want? In the best-case scenario, the patient, family, and healthcare providers have discussed treatment options and preferences and documented these wishes in the form of an advance care plan. This way, everyone is prepared for eventual crises because they have agreed on a clear care plan that reflects the patient's values.

Although the issue has been increasingly in the public eye, few patients have had these discussions with their physician or family; and, even when they have, decisions may not be documented in the patient's record. Without plans, a crisis situation can escalate quickly, especially if the patient cannot communicate or if the family's preferences conflict with the clinician's. In these cases, treatment decisions are not made, they simply happen, usually based on habits that are presumed to reflect what patients generally want.

Decisions about naming a proxy decision-maker or about future care can be documented in legally authorized advance directives (ADs), such as living wills, or durable powers of attorney for health care (DPOAHC). ADs, however, are only one component of a more comprehensive approach called advance care planning (ACP). ACP results from a continuing dialogue between the patient, family, and healthcare providers, aiming to tailor clinical care to the patient's preferences and values, as well as to his or her clinical situation.

ACP can be challenging for the following reasons:

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