Care Transformation Center Blog

The ABCDEs of advance care planning

Last Wednesday was National Healthcare Decisions Day, which is part of a national focus on end-of-life planning and advance directives.

By discussing patient preferences on care options at the end of life, providers can deploy health care resources more appropriately and promote a better patient experience. An important component of advance care planning—completion of advance directives—is a key target for providers given that only 25% of U.S. adults age 18 and older have an advance directive.

This time last year, we shared two strategies from Dr. Ferdinando Mirarchi, a leading expert on advance directives and the medical director of UPMC Hamot’s emergency department:

  • Translate legal jargon into language medical personnel will readily understand
  • Integrate a provider "checklist" into end-of-life care to ensure that patient's wishes are fully understood and integrated into the care plan

I recently caught up with Dr. Mirarchi to follow up on last year's interview and to discuss how to better engage patients in completing an advance directive.

Target at-risk patient groups

It’s never too early to think about advance care planning. When an illness escalates or if there is an accident, it is often stressful and emotionally difficult for a patient to fully understand and determine what their care goals should be. To avoid this situation, providers can preemptively offer education programs and patient tools for advance care planning, prioritizing two key groups:

  • Those whose health status puts them at risk for increased health care utilization
  • Patients whose demographics (e.g., language, race, age, etc.) are traditionally associated with low utilization of advance directives

Use a patient 'checklist' during treatment discussions

When a patient is critically ill and reaches a decision point, providers should take a "time out" to ensure that all care team members—including the patient and his/her family—are clear about the patient’s prognosis and preferences for care.

An A-B-C-D-E checklist, which complements the checklist Dr. Mirarchi developed for providers to use during a "resuscitation pause," can be used by patients to facilitate these conversations with their care team:

  • Announce to the medical team that you have an advance directive (e.g., a living will, DNR, health care power of attorney)
  • Be clear with the medical team about your intentions for treatment in the face of executing the advance directive
  • Communicate and coordinate with family members to ensure everyone understands the treatment plan
  • Discuss next steps
  • Explore the benefits of palliative and/or hospice care

While patient education programs and checklists help encourage adoption of advance directives, they are just one component of advance care planning for population health.

Population managers may also use care managers to support patients as they make and review their advance care decisions, develop mechanisms to share patients’ wishes across care settings and providers, and ensure high-quality hospice and palliative care services are available to patients.

Ultimately, an organization that promotes advance care planning will improve the quality of care delivered to patients while better managing and allocating health care resources.

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