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Advance Care Planning and the Cost of Pragmatism

Advance Care Planning and the Cost of Pragmatism Opinion EDITORIAL Vinay Guduguntla, MD; Tracy Wang, MD, MHS, MSc; Deborah Grady, MD, MPH Advance care planning (ACP) is a stepwise process that cal processes can increase ACP code awareness and use. More addresses patient preferences for advance directives, importantly, it can result in patient-centric benefits, such as durable power of attorney, and end-of-life care. These dis- the designation of surrogates and completion of advance di- rectives. Over time, this approach may help decrease the cussions often lead to higher-quality, goal-concordant care for patients. Yet, ACP rarely oc- delivery of low-value end-of-life care. curs in the ambulatory care In the trial, participants were randomized before provid- Related article page 361 setting. More- over, current ing consent, and then only patients in the experimental arm approaches to ACP often fail to engage patients and their fami- were approached, provided consent, and received the inter- lies or are not well integrated into clinician workflow. vention if desired. To maintain randomized comparisons, all In this issue of JAMA Internal Medicine, Gabbard et al as- participants who were assigned to the intervention arm (irre- sessed the efficacy of a nurse navigator and electronic health spective of consent) were analyzed as part of the http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Internal Medicine American Medical Association

Advance Care Planning and the Cost of Pragmatism

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Publisher
American Medical Association
Copyright
Copyright 2021 American Medical Association. All Rights Reserved.
ISSN
2168-6106
eISSN
2168-6114
DOI
10.1001/jamainternmed.2020.5935
Publisher site
See Article on Publisher Site

Abstract

Opinion EDITORIAL Vinay Guduguntla, MD; Tracy Wang, MD, MHS, MSc; Deborah Grady, MD, MPH Advance care planning (ACP) is a stepwise process that cal processes can increase ACP code awareness and use. More addresses patient preferences for advance directives, importantly, it can result in patient-centric benefits, such as durable power of attorney, and end-of-life care. These dis- the designation of surrogates and completion of advance di- rectives. Over time, this approach may help decrease the cussions often lead to higher-quality, goal-concordant care for patients. Yet, ACP rarely oc- delivery of low-value end-of-life care. curs in the ambulatory care In the trial, participants were randomized before provid- Related article page 361 setting. More- over, current ing consent, and then only patients in the experimental arm approaches to ACP often fail to engage patients and their fami- were approached, provided consent, and received the inter- lies or are not well integrated into clinician workflow. vention if desired. To maintain randomized comparisons, all In this issue of JAMA Internal Medicine, Gabbard et al as- participants who were assigned to the intervention arm (irre- sessed the efficacy of a nurse navigator and electronic health spective of consent) were analyzed as part of the

Journal

JAMA Internal MedicineAmerican Medical Association

Published: Mar 11, 2021

References