Advance Care Planning: Barriers, Performance Improvement, Family Education about Hospital Transfers

​Although virtually all physicians who treat older patients consider conversations about advance care planning important, structural barriers exist in initiating these conversations, found a study conducted by PerryUndem Research/Communication. For example, just 29% of the 736 respondents to a national telephone survey said their practice or healthcare system had a formal system for assessing patients' end-of-life wishes and goals for care. In addition, only 29% said they had formal training on talking with patients about end of life. In responding to a question about difficulties with healthcare decision making even when individuals have advance directives such as "do not resuscitate" orders and healthcare proxies, a columnist writing in the April 2016 Caring for the Ages emphasizes that advance care planning goes beyond decisions about resuscitation and identification of proxies. Medical practitioners need to discuss prognosis, which is the "probable course of disease" and is not the same as life expectancy, in enough detail to allow residents and families to make informed decisions.