Advance Care Planning: Tying a Community Perspective to the National Conversation

August 22, 2016

ACP papers reading "Living Will" and "HealthCare Power of Attorney" with a pen laid on top of them.Advance care planning (ACP) is a process where people talk with family members and doctors about their end-of-life care preferences and designate someone to carry out their wishes. ACP helps people plan for future medical treatment in the event of a serious illness. Controversies associated with ACP—perhaps most famously the accusations of “death panels” that demonized the Affordable Care Act—have sometimes overshadowed substantial research on the ACP’s benefits. Research shows that the preferences of patients who engage in ACP are more likely to be known and followed, and ACP reduces the burden of medical decision-making among family members. Even with these benefits, few Americans, including older adults, have engaged in advance care planning.

Leaders in geriatrics have argued for national- and community-level policy change to create an environment conducive to ACP. In order to improve the environment for ACP, however, it is essential to understand the current obstacles. To that end, the Washtenaw Health Initiative (WHI), a volunteer collaborative in Washtenaw County, Michigan, examined community barriers and their relationship to nationally identified barriers. In early 2016, the WHI conducted a series of focus groups and interviews with over 80 Washtenaw County community members and physicians to understand the community’s experiences and challenges with ACP. This brief summarizes key findings and policy recommendations related to challenges to ACP, based on the focus groups and interviews and a review of relevant literature.