Do you know what Advance Care Planning (ACP) is? It involves preparing and discussing future medical care decisions where someone can no longer advocate for themselves. It is the planning for future medical care if a person cannot make decisions for oneself due to serious medical situations. ACP allows for appropriate care for the patient even when they cannot speak for what they want.
There are four types of communication of ACP. The first and simple one is a discussion with family members and healthcare providers. The second one includes Advance Directives (ADs) and legal forms such as Do Not Resuscitate (DNR), Do Not Attempt Resuscitation (DNAR), Allow Natural Death (AND), and Physician Orders for Life-Sustaining Treatment (POLST). The most common forms of ADs are living will and Durable Power of Attorney of Health Care (DPAHC). A living will specify in writing what care the patient wants, and DPAHC is someone the patient gives legal power to so that s/he can make decisions on behalf of the patient. POLST provides specific medical orders for patients with seriously advanced illnesses, and Ads, general wishes, are for all adults.
So all adults should complete an AD and update it periodically. When diagnosed with advanced illness or frailty, they complete a POLST form. When health status changes, POLST will be updated, and treatment wishes will be honored.
ACP has many benefits, such as respecting one’s autonomy, considering family members’ well-being, reducing care expenses, and reducing futile, unnecessary, or unwanted medical treatment.
The Patient Self-Determination Act of 1990 requires all Medicare and/or Medicaid-funded facilities to provide patients with written information on AD at enrollment. Studies have shown that people in urban areas are more likely to apply and participate in Ads because they have increased access to healthcare facilities compared to individuals in rural areas. Married individuals and individuals with children engage in Ads more often. With a growing number of seniors living alone in America, it is imperative to enhance advocacy efforts to improve the completion rate of ADs.
