Advance care planning re-imagined: a needed shift for COVID times and beyond

TLDR: The use of advance care planning is a widespread recommendation for those patients who have life limiting illnesses, but the evidence base for taking this approach needs expanding and higher quality trials are needed to be able to demonstrate scientific evidence of effectiveness.

Abstract: Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Introduction While the use of advance care planning (ACP) is a widespread recommendation for those patients who have life limiting illnesses, the evidence base for taking this approach needs expanding. A systematic review in 2014 found some positive impact in the use of ACP.1 A further systematic review in 20162 of randomised controlled trials suggested that the evidence was open to bias and that higher quality trials are needed to be able to demonstrate scientific evidence of effectiveness. Part of the problem lies in differing outcome measures and lack of differentiation between Do-Not-Resuscitate orders, Preferred Place of Care, Preferred Place of Death and Treatment Escalation Plans.