1158F Advance care planning discussion documented in the medical record (COA)

Name of the Procedure:

Advance Care Planning Discussion Documented in the Medical Record (COA)

Common name(s): Advance Care Planning, ACP Discussion

Summary

Advance care planning is a process that helps patients think about and communicate their preferences regarding future healthcare. This includes discussions about desired medical care and interventions in case of serious illness or incapacity.

Purpose

Advance care planning addresses the need for patients to express their medical care preferences in situations where they may not be able to communicate their decisions themselves. The goals include ensuring that patients' wishes are known, respected, and documented, and that caregivers and family members are guided in making healthcare decisions on behalf of the patient.

Indications

• Chronic or life-threatening conditions (e.g., cancer, heart failure, dementia).
• Elderly patients or those with declining health.
• Patients undergoing major surgeries or high-risk procedures.
• Patients wanting to detail preferences for specific future medical situations.

Preparation

• Patients may be asked to reflect on their values, beliefs, and healthcare goals.
• Reading materials or questionnaires about advance care planning may be provided beforehand.
• No specific fasting or medication adjustments are typically required.

Procedure Description

1. The healthcare provider initiates a conversation about the patient's values, goals, and preferences regarding medical care.
2. Discussion topics include:
   • Desired level of medical intervention in various scenarios.
   • Preferences regarding life-sustaining treatments (e.g., ventilators, feeding tubes).
   • Designation of a healthcare proxy or power of attorney.
3. The patient's preferences are thoroughly documented in their medical record.
4. The ACP document may be periodically reviewed and updated as needed.

Duration

Typically, the discussion lasts between 30 minutes to an hour.

Setting

The procedure is usually performed in an outpatient clinic, hospital, or the patient's home.

Personnel

• Primary care physician or specialist.
• Nurses or nurse practitioners.
• Social workers or patient advocates.
• Sometimes, legal advisors may be involved.

Risks and Complications

No medical risks or complications are associated with the discussion itself. Emotional distress or disagreement among family members may occur, requiring sensitive handling by the healthcare team.

Benefits

• Ensures patient’s healthcare preferences are known and respected.
• Provides clarity and guidance for family and caregivers.
• Reduces anxiety about future medical decisions.
• Can prevent unnecessary or unwanted medical interventions.

Recovery

No physical recovery is required. Emotional support may be provided if needed. Follow-up appointments may be scheduled to review and update the advance care plan as the patient’s condition evolves.

Alternatives

• Informal discussions with family members (though these are less legally binding).
• Legal documents such as living wills or healthcare power of attorney without medical discussion.
• Not creating an advance care plan (which risks not having preferences known or followed).

Patient Experience

Patients may feel relief and empowerment from discussing their future care preferences. Emotional responses are common and are managed through supportive communication. Pain management and physical comfort measures are not typically needed, as the procedure is conversational.