Kristin Levoy, PhD, MSN, RN, discusses the findings from and reasons behind a meta-analysis of studies on outcomes of advance care planning in patients diagnosed with cancer.
There’s been some opinion pieces that have surfaced in the last year in some of the palliative care journals that say advance care planning isn’t working, and why continue to invest more money in this process? I think we need to be a little bit more precise about how we’re studying advance care planning so that we’re really on solid ground when we say, “Let’s throw everything out and start from scratch.” And I don’t think that that’s appropriate given our findings. We conducted a meta-analysis to really provide some clarity on what the actual impact of advance care planning is at the end of life. There’s a lot of studies that may say it’s positive or it may say it has no effect or has mixed effects and so we were wanting to provide some clarity around that. And the best way to do that is to take the actual statistical output from a multitude of studies and run them as a collective whole.
I think that we still have not moved away from treating advance care planning as a one-and-done checkbox procedure. It is an ongoing conversation between the patient, the caregiver and the provider across the illness trajectory, ultimately those conversations are documented and updated over time as patients’ preferences change.
It’s natural for preferences to change based on experiences that patients have across a cancer illness trajectory where they become more informed of what they want.
Our study really provides evidence of the value of advance care planning and that it is, from a healthcare policy standpoint, something that’s here to stay. It just underscores the fact that there is some room for improvement in how we think about implementing advance care planning and moving towards a national standard.