Advance Care Planning Improves Quality of Life, Reduces Anxiety

Advance care planning discussions reduced and staved off feelings of anxiety for seriously ill patients.

By Sara Heath

March 19, 2019 - Early interventions and patient-centered advance care planning communication can improve patient-reported outcomes and quality of life for individuals with a serious illness, according to researchers from Dana Farber Cancer Institute.

Advance care planning, or communications about patient values, needs, and goals when nearing the end of life, is a key priority in driving positive patient experiences. These discussions between patient and provider increase the likelihood that a patient will receive care that aligns with her personal values and her preferred quality of life.

But these communications often fall by the wayside. Doctors may not feel comfortableengaging in advance care planning, and in many cases lack the resources to improve in this area.

In this latest study, published in the Journal of the American Medical Association, palliative care researchers highlight the efficacy of one advance care planning guide that can improve a patient’s quality of life.

“We know how beneficial patient-centered conversations are, and our goal is to ensure that they happen for all patients, earlier in the course of illness and focus on what matters most to the patients,” said study author Rachelle Bernacki, MD, MS, associate director of the Serious Illness Care program and a palliative care doctor at Dana-Farber Cancer Institute.

“These results are exciting because they show us that more, better and earlier conversations are possible and they can reduce symptoms of depression and anxiety in our most vulnerable patients,” Bernacki said.

The researchers introduced the Serious Illness Care Guide to 91 doctors, nurse practitioners, and physician assistants treating 278 patients. The guide trains clinicians in how to carry out advance care planning conversations with patients.

The guide specifically outlines how to assess patient understanding of prognosis, patient values and personal goals, fears and sources of strength, capabilities that are essential to good quality of life, and the types of treatments patients are willing to endure for more time.

The program also includes a nearly three-hour training program during which clinicians learn how to detect patients who may benefit from advance care planning, review the guide, and receive communication coaching.

Palliative care and psychology specialists emphasize how to engage in empathic and gentle conversations with seriously ill patients.

Following introduction to the guide, providers began engaging patients in advance care planning an average of 2.4 months earlier than they typically would. Ninety percent of patients ended up discussing their personal care goals and values for the end of life, which in turn improved quality of life and reduced anxiety.

Specifically, the number of patients experiencing moderate to severe anxiety was cut in half. The intervention staved off high anxiety for about 24 weeks in the average patient, the researchers reported.

However, the study did not confirm that advance care planning improved clinical outcomes or resulted in treatment that was truly concurrent with patient goals and desires. This was likely due to some study limitations, such as an unexpectedly low death rate and low survey response rate, the researchers said.

Nonetheless, the results reveal that revamping advance care planning talks can improve the care experience for patients, said Susan Block, MD, the founding chair of the Department of Psychosocial Oncology and Palliative Care at Dana Farber.

“Effective and meaningful communication is one of the most important tools of good-quality medicine, especially when patients are dealing with challenging health issues,” said Block, who is also a Professor of Psychiatry and Medicine at Harvard Medical School and the palliative care specialist who led the creation of the Serious Illness Care Program at Ariadne Labs.

“We believe that this intervention addresses this need for patients, and also supports clinicians by making it easier for them to have these conversations, through providing them with supportive tools to have what can often be very tough conversations.”

What’s more, this strategy equips clinicians with a new skillset that will help fill in care gaps. Advance care planning responsibilities often fall on palliative care specialists or case workers, who are few and far between in the healthcare industry.

Training clinicians in how to carry out advance care planning discussions will ensure they actually occur, according to study co-author Joanna Paladino, who leads implementation of the Serious Illness Care Program at Ariadne Labs.

“We have a dire shortage of palliative care clinicians in the United States and many patients who would benefit from patient-centered, safe and gentle serious illness conversations,” Paladino said. “What we found is that with communication skills training, a structured conversation guide and system-level support, we can equip many more clinicians to have these conversations.”

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