What Are the Elements of Advance Care Planning and What Is the Evidence That Advance Care Planning Changes Patient Outcomes?

Patients and families facing a serious illness are confronted with multiple decisions about medical care. These decisions are high-stakes, are stressful for all involved, and have numerous downstream effects for patients, families, providers, and the health care system. Advance care planning (ACP) seeks to improve this decision-making process by preparing for these moments ahead of time. While ACP was initially developed to ensure that the patient’s voice was respected in case of future incapacity, it has expanded to include any decision making for future care. The future decision may be decades away (early ACP for healthy patients) or only weeks away (planning in the case of seriously ill patients). ACP has been developed and studied for more than 30 years. In the past 10 years, the field has evolved significantly in defining ACP, clarifying the possible outcomes, and obtaining data on ACP’s impact. As the growing evidence has shown mixed outcomes, many clinicians have raised questions about where they should focus their ACP efforts. This chapter will review ACP’s definition and the data regarding early and late ACP and advance directives (AD). The chapter also discusses the evidence for ACP and methods for engaging in ACP with patients and families.