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advance care planning

A process for identifying & communicating a patient's preferences for health care in the future, in the event that the patient becomes unable to make health care decisions for himself/herself. Caveats: a) may be done outside of health care setting b) may be done by anyone with decision-making capacity c) may or may not involve health care professionals directly d) may or may not result in a written advance directive Procedure: - establish an understanding of what makes life meaningful to patient "what brings you happiness?" - explore what medical treatments might help meet patient goals [3] Notes: - does not improve quality of life [1] - does not affect use of medical care - does increase completion of advance directives & appointment of surrogate decision-makers [1] - interactive online advance care planning program called PREPARE [2] - written at a fifth-grade level - includes videos that address choosing a medical decision maker & preferences for life-sustaining treatment

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advance directives

References

  1. Overbeek A, Korfage IJ, Jabbarian LJ et al Advance Care Planning in Frail Older Adults: A Cluster Randomized Controlled Trial. J Am Ger Soc. ePub: April 2, 2018 PMID: 29608789 https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15333
  2. Freytag J, Street RL Jr, Barnes DE et al. Empowering older adults to discuss advance care planning during clinical visits: The PREPARE randomized trial. J Am Geriatr Soc 2020 Jun; 68:1210. PMID: 32157684 https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16405
  3. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  4. Bravo G, Sene M, Arcand M, et al. Effects of advance care planning on confidence in surrogates' ability to make healthcare decisions consistent with older adults' wishes: Findings from a randomized controlled trial. Patient Educ Couns. 2018;101(7):1256-1261 PMID: 29452728 https://www.sciencedirect.com/science/article/abs/pii/S0738399118300521
  5. Centers for Medicare & Medicaid Services. Advanced Care Planning MLN Fact Sheet. August 2019. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/advancecareplanning.pdf
  6. VHA Handbook 1004.02 Veterans Administration