title: Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel.
abstract: Despite increasing interest in advance care planning (ACP) and previous ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives.
  
  
  
  The aim of this study was to develop a consensus definition of ACP for adults.
  
  
  
  We convened 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. We conducted 10 rounds using a modified Delphi method and qualitatively analyzed panelists' input. Panelists identified several themes lacking consensus and iteratively discussed and developed a final consensus definition.
  
  
  
  Panelists identified several tensions concerning ACP concepts such as whether the definition should focus on conversations vs. written advance directives; patients' values vs. treatment preferences; current shared decision making vs. future medical decisions; and who should be included in the process. The panel achieved a final consensus one-sentence 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 strategies to best support adults in ACP.
  
  
  
  A multidisciplinary Delphi panel developed a consensus definition for ACP for adults that can be used to inform implementation and measurement of ACP clinical, research, and policy initiatives.
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA. Electronic address: rebecca.sudore@ucsf.edu.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Sudore
authors.affiliation: VA Eastern Colorado Geriatrics Research Education and Clinical Center (GRECC), Denver, Colorado, USA; Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Hillary D
authors.initials: HD
authors.lastname: Lum
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: John J
authors.initials: JJ
authors.lastname: You
authors.affiliation: Division of Geriatric Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Hanson
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Diane E
authors.initials: DE
authors.lastname: Meier
authors.affiliation: Palliative Care Program, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California, USA.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Pantilat
authors.affiliation: VA Eastern Colorado Geriatrics Research Education and Clinical Center (GRECC), Denver, Colorado, USA; Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Matlock
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Judith A C
authors.initials: JAC
authors.lastname: Rietjens
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Ida J
authors.initials: IJ
authors.lastname: Korfage
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ritchie
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Jean S
authors.initials: JS
authors.lastname: Kutner
authors.affiliation: Division of Gerontology and Geriatrics, University of Washington, Seattle, Washington, USA.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Teno
authors.affiliation: Coalition for Compassionate Care of California, Sacramento, California, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: McMahan
authors.affiliation: Department of Critical Care Medicine, Queen's University; Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000145:classification* / Q000592:standards*; D002908:Chronic Disease / Q000145:classification* / Q000628:therapy*; D003657:Decision Making; D003697:Delphi Technique; D005260:Female; D006801:Humans; D000075762:Interdisciplinary Research / Q000592:standards; D038622:Internationality; D008297:Male; D017410:Practice Guidelines as Topic; D009626:Terminology as Topic
keywords: Advance care planning; Delphi technique; consensus; policy making