Implementation of Advance Care Planning in Oncology: A Review of the Literature

Advance care planning (ACP) should be initiated early and be readdressed often for patients with cancer. This directive is expressed in the Institute of Medicine's report, Dying in America, and is a component of several quality metrics, including ASCO's Quality Oncology Practice Initiative and the Centers for Medicare & Medicaid Services Oncology Care Model. Although simple in concept, implementation in practice is challenging. A variety of patient education tools exist in several different forms, including pamphlets, guidebooks, and question prompt lists, with the strongest data supporting the use of video decision aids that depict cardiopulmonary resuscitation. These educational tools should address topics that include anticancer treatment, cardiopulmonary resuscitation, and health care surrogates. Physician prompts in the electronic health record to discuss ACP should be considered. Health care provider training should be offered to meet the needs and comfort level of the practitioners who conduct the intervention. Intervention studies that assessed ACP documentation rates as the primary end point increased documentation from 15% to 30% to 40%. Additional well-conducted randomized studies are needed to understand the intervention characteristics that can further improve the completion and documentation of ACP. Further research is needed to determine if there is a difference in outcome based on which provider conducts ACP as well as how to maximize the benefits of the electronic health record, such as prompts to readdress ACP.