Value Snapshot: Advance care planning

Advance care planning promotes compliance with patients’ wishes and improves satisfaction

Advance care planning (ACP) extends patient autonomy by allowing individuals, particularly those with progressive illness, to reflect on and articulate their preferences for medical care in advance of medical crises that might impede their ability to speak for themselves.

Through the mechanisms of open communication and the explicit documentation of preferences, ACP can help patients and families have greater control over how and where they engage with the health care system. By promoting concordance between care delivered and patient preferences, ACP programs have positive effects on patient and family satisfaction and mental health. Several recent trials and well-designed cohort studies have validated these claims.

For example, Morrison and colleagues found that in nursing homes that provided ACP education and discussions, residents were more likely to have their preferences documented (p<0.01) for CPR, artificial nutrition, intravenous antibiotics, and hospitalization, and were much more likely to have their wishes respected (p<0.04).1)Morrison RS, Chichin E, Carter J, et al. The effect of a social work intervention to enhance advance care planning documentation in the nursing home. J Am Geriatr Soc 2005; 53(2): 290–294.

ACP impact on knowledge of and compliance with patients wishes

ACP is also valued by patients and families. In a randomized trial that studied the impact of a complex ACP program, Detering and colleagues found that satisfaction was higher among patients and families who received ACP, and that family members of patients who died had significantly less post-traumatic stress (p<0.001), anxiety (p=0.02), and depression (p=0.002) than did families of patients who received usual care.2)Detering KM, Hancock AD, Reade MC, et al. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ 2010; 340: c1345. ACP discussions were also associated with earlier hospice referral, which was in turn associated with improved patient and family quality of life.3)Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 2008; 300(14): 1665–1673.

ACP impact on patient and family satisfaction

Download this Value Snapshot on advance care planning as a PDF.

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Developed with support from the California HealthCare Foundation.


Kathleen KerrKathleen Kerr is a healthcare consultant in private practice. She has expertise in palliative care, quality improvement and program evaluation, with particular interest in assessing financial outcomes. Her professional experience includes more than a decade of work as a senior analyst in the Department of Medicine at the University of California, San Francisco, where she participated in educational, technical assistance and research efforts focused on quality, safety, hospitalist financial and clinical outcomes, medical education and palliative care.

References   [ + ]

1. Morrison RS, Chichin E, Carter J, et al. The effect of a social work intervention to enhance advance care planning documentation in the nursing home. J Am Geriatr Soc 2005; 53(2): 290–294.
2. Detering KM, Hancock AD, Reade MC, et al. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ 2010; 340: c1345.
3. Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 2008; 300(14): 1665–1673.

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