An approach to advance care planning in the office.
OBJECTIVE
To outline how advance care planning is a process of communication among patients, their families, and health care providers regarding appropriate care for patients when they are no longer able to make decisions for themselves.


METHODS
Level I evidence supports systematic implementation of advance care planning under controlled circumstances, such as in institutions. Level II evidence supports exploring factors that determine treatment preferences and change treatment preferences and other factors that complicate the process of end-of-life decision making. Level III evidence supports the approach to advance care planning in the office described in this article.


RESULTS
Family physicians can help prevent the suffering of patients with chronic illnesses by facilitating discussion of end-of-life issues. The approach suggested in this article will help reduce avoidance of the issues and minimize the difficulty of discussing issues crucial to patients and their families.


CONCLUSIONS
Advance care planning can prevent suffering and enable patients to receive care congruent with their goals at the end of their lives. Family physicians can be key to facilitating this process.
Gallagher
Romayne
R
Division of Residential Care for Providence Health, Vancouver, BC. rgallagher@providencehealth.bc.ca
D032722:Advance Care Planning; D000368:Aged; D003657:Decision Making; D004282:Documentation; D005194:Family Practice; D005260:Female; D006801:Humans; D010817:Physician-Patient Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy