Despite the uncertainties brought on by the COVID-19 pandemic, advance care planning remains critical. With death tolls and confirmed cases rising, advance care planning is increasingly vital, particularly for high-risk patient populations receiving hospice and palliative care.
Severe illness and possible death are among the risks posed by the novel coronavirus, according to the U.S. Centers for Disease Control and Prevention (CDC). As of today, the CDC reported more than 186,000 confirmed cases and more than 3,600 deaths nationwide.
“The COVID-19 crisis has made advance care planning even more acute,” said Ryan Van Wert, M.D., co-founder and CEO of Vynca, a nationwide advance care planning network. “A lot of the focus right now is appropriately on things like increasing [intensive care unit (ICU)] capacity, increasing overall hospital capacity, increasing ability of diagnostic testing, all these are absolutely important. But we also have to recognize and look at the demographics of where COVID-19 impacts people the most. And unfortunately, it hits people who are more elderly the hardest, and it’s these people who have existing conditions, serious illness and otherwise.”
While planning ahead during a pandemic of this magnitude is challenging, hospice and palliative care providers can help manage the unknowns by having open discussions with patients and families about their existing health issues and end-of-life care wishes before situations become dire emergencies.
According to a 2017 report published by the Kaiser Family Foundation and The Economist, a little over half of people in the United States had end-of-life conversations with loved ones, with less than 20% having these discussions with their providers. Only 27% had formally documented their wishes in advance directives or Physician Orders for Life-Sustaining Treatment (POLST) forms. However, advance care planning conversations are vital in today’s climate as severe cases of the coronavirus disease leading to an uptick of deaths.
In addition to addressing patient concerns, advanced care planning can also benefit providers on the front lines of the COVID-19 crisis. As health care systems become overwhelmed with staffing shortages, a common challenge is having the time and capacity for critical care discussions and deciding on the best course of treatment to take in a patient’s final days. Those final days are coming at a severity level and overwhelming rate of speed across health care settings, with the highest risks in hospice and palliative care patients.
Studies show that advance care planning can reduce hospitalizations by as much as 26%, reduce health care costs, increase community-based palliative care and hospice utilization, as well as significantly increase the likelihood that care will be delivered in accordance with the patient’s wishes.