March 22, 2021 ‐ PSQH

By Matt Phillion

It’s something many healthcare professionals and organizations are well aware of: Advance care planning and end-of-life preferences are an oft-overlooked part of patient care to be improved upon.

But it isn’t just about being aware of patient preferences. Ensuring every patient’s end-of-life care preferences are documented and accessible also works to reduce harm and improve patient outcomes.

A year living through a pandemic has made this issue even more abundant—older patients, and those with chronic conditions, have been among those most at risk for severe, life-threatening conditions, including those attached to COVID-19. And what happens when one of these patients is placed on a ventilator, unable to voice their wants in terms of treatment?

To avoid these scenarios, the industry needs to ensure providers, caregivers, patients, and families are engaged in advance care planning discussions.

“Providing goal-concordant care to individuals at end of life is absolutely a patient safety issue,” says Ryan Van Wert, MD, an intensive care physician, a part-time clinical assistant professor at Stanford University, and co-founder and CEO of Vynca, an advance care planning solution organization. “It absolutely fits into quality measures and value-based paradigms.”

Advance care planning is an underrecognized issue, but its status has been elevated during the COVID-19 pandemic, Van Wert notes. It rose to the forefront at the outset of the pandemic, making sure everyone’s voice was heard, he adds. “Certain demographics were at the highest risk, but I think the message was that nobody was really safe. Everyone had the potential to get seriously ill, and that brought it home to a lot of people.”

Our time with COVID-19 has forced many patients, families, and providers to reflect on what would happen if the unthinkable does occur. Do you have a mechanism through which your wishes could be honored?

“The challenge with advance care planning is in reality, it’s a very complex process to implement and scale in a high-quality, consistent way,” says Van Wert.

Unique Challenges to Implementation

To start, advance care planning isn’t something that should be done on the fly, Van Wert notes.

“These are difficult decisions. They take time,” he says. “And providers are often not trained for it. There’s often a default in healthcare that you do everything to save the patient until you’re instructed otherwise. It’s an aggressiveness of care.”

Physicians and other care providers, without the proper guidance of advance care planning, can only do what they believe is the right thing. And yet patients don’t often ensure their wishes are clearly documented.

“We know from the data that advance care planning for populations 65-plus is often in the single-digit percentages,” says Van Wert.

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