Quality Improvement Reports and White Papers

Sudore, R. L., Lum, H. D., You, J. J., Hanson, L. C., Meier, D. E., Pantilat, S. Z., et al. Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel. Journal of Pain and Symptom Management, 53(5), 821-832 e821. doi:10.1016/j.jpainsymman.2016.12.331

This work represents the first consensus-based advance care planning definition developed using Delphi methodology and offers a uniform framework in which to define patient-centered ACP outcomes, ACP clinical interventions, and ACP policy. A Delphi panel of multidisciplinary, international ACP experts consisting of 52 clinicians, researchers, and policy leaders from four countries and a patient/surrogate advisory committee was convened to determine a consensus definition of advance care planning to guide clinical, research, and policy initiatives. Ten rounds using a modified Delphi method and qualitatively analyzed panelists’ input occurred in 2015. The panel achieved a final consensus definition and accompanying goals statement: ‘‘Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. The goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness.’’ The panel also described recommendations for clinical and policy strategies to support adults in ACP.

Institute of Medicine. (2014). Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, D.C., National Academies Press. http://www.nationalacademies.org/hmd/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx

This consensus report from the Institute of Medicine (IOM) finds that improving the quality and availability of medical and social services for patients and their families could not only enhance quality of life through the end of life, but may also contribute to a more sustainable care system. Chapter 3 focuses on Clinician–Patient Communication and Advance Care Planning. Professional societies and other organizations that establish quality standards should develop standards for clinician–patient communication and advance care planning that are measurable, actionable, and evidence based. “One of the best-known advance directive initiatives is Respecting Choices®. The program produces educational materials for patients; trains facilitators to discuss end-of-life questions with patients and prepare them for the end of life; and ensures that advance directives are available in patients’ medical records, now electronically.” Making such a program work effectively requires embedding advance care planning in the community’s larger health system to enable professionals to communicate and collaborate on making improvements, creating ongoing monitoring and feedback loops for quality improvement, and sustaining the effort with ongoing financial support and staff training (Hammes, 2003).

A National Framework for Advance Care Directives—September 2011. Australian Health Ministers’ Advisory Council.

Advance Care Planning Australia (ACPA) is a national program funded by the Australian Government Department of Health. This report combines new and existing concepts and describes the goals for policy and practice across Australia. A national code for ethical practice and best practice standards was established for advance care directives and advance care planning. The Respecting Choices® model and approach to person-centered care has been adopted as best practice.

Introduction: The Issue

Respecting Choices Faculty have received significant feedback on concerns from advance care planning (ACP) Facilitators, physicians, and others in facilitating the cardiopulmonary resuscitation (CPR) conversation, specifically regarding CPR outcome statistics, and from Instructors in effectively teaching CPR facilitation skills to others.

This position paper is intended to make recommendations for those who facilitate conversations about the CPR decision and Instructors who teach the CPR content.

CPR Position Paper

Advance Directives and Advance Care Planning Report: Report to Congress—August 2008. U.S. Department of Health and Human Services, Office of Disability, Aging and Long-Term Care Policy.

This report was prepared through a contract with RAND Health (Neil S. Wenger, M.D., M.P.H., Lisa R. Shugarman, Ph.D., with Anne Wilkinson, Ph.D.) and staff from the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (including Judith Peres, L.C.S.W.-C.). In addition, specific commissioned papers by Myra Christopher, John Carney, M.Ed., Charles Sabatino, J.D., and Gary Stein, J.D., M.S.W. are reflected in this work.