Citing an Institute of Medicine (IOM) report that is critical of current approaches to end-of-life care, the authors of a viewpoint article in the March 17, 2015, Journal of the American Medical Association propose web-based approaches to improve advance care planning. The IOM report, Dying in America, said patients often receive "undesired, burdensome" treatments at the end of life and called for improvements in advance care planning. The viewpoint authors write that the current approach to advance care planning focuses on the signing of legal documents (i.e., advance directives) and has limited effect in engaging patients and their families about their needs and values. Conversely, another model for advance care planning, using trained facilitators to engage patients and families about their goals, is difficult to scale up to meet the needs of many. As an alternative, the authors propose web-based approaches, noting the success of a novel website, PREPARE, to prepare older adults for advance care planning. Among the benefits of web-based approaches are the following: consistency with a general societal trend to use web-based technology, proven success in using web-based tools for medical issues, minimal cost compared with facilitator training, ability to help people envision their needs by showing videos of examples of life in different health states, and capacity to accommodate interactive exercises for patients and their families. The viewpoint authors caution that the web-based tools must be guided by principles of user-centered design (e.g., usable to diverse groups, tested with multiple target groups) to help "propel advance care planning into the 21st century."

HRC Recommends: Many individuals lack advance directives but would formulate one if given the opportunity. Linguistic, cultural, and socioeconomic factors may act as barriers to implementing advance directives and must be considered when providing information about advance directives. Education can improve communication among physicians and patients about end-of-life decision making. Additionally, misinterpretation of advance directives is a patient safety issue that should be captured in reporting systems.