Mary Butler, PhD, MBA; Edward Ratner, MD; Ellen McCreedy, MPH; Nathan Shippee, PhD; Robert L. Kane, MD
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Financial Support: This project was conducted by the Minnesota EPC under contract HHSA 290 2012 00016 1 to AHRQ.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0644.
Requests for Single Reprints: Mary Butler, PhD, MBA, Minnesota Evidence-based Practice Center, University of Minnesota School of Public Health, 420 Delaware Street SE, MMC 197, Minneapolis, MN 55455; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Butler and Kane: University of Minnesota School of Public Health, D-351 Mayo, MMC 197, 420 Delaware Street SE, Minneapolis, MN 55455.
Ms. McCreedy: Minnesota Evidence-based Practice Center, University of Minnesota School of Public Health, 420 Delaware Street SE, MMC 197, Minneapolis, MN 55455.
Dr. Ratner: University of Minnesota, 420 Delaware Street SE, MMC 741, Minneapolis, MN 55455.
Dr. Shippee: University of Minnesota School of Public Health, D-375 Mayo, MMC 729, 420 Delaware Street SE, Minneapolis, MN 55455.
Author Contributions: Conception and design: M. Butler, E. Ratner, N. Shippee, R.L. Kane.
Analysis and interpretation of the data: M. Butler, E. Ratner, E. McCreedy, N. Shippee, R.L. Kane.
Drafting of the article: M. Butler, N. Shippee.
Critical revision of the article for important intellectual content: M. Butler, E. Ratner, N. Shippee, R.L. Kane.
Final approval of the article: M. Butler, E. Ratner, N. Shippee, R.L. Kane.
Obtaining of funding: M. Butler, R.L. Kane.
Administrative, technical, or logistic support: R.L. Kane.
Collection and assembly of data: E. Ratner, E. McCreedy.
Advance care planning honors patients’ goals and preferences for future care by creating a plan for when illness or injury impedes the ability to think or communicate about health decisions. Fewer than 50% of severely or terminally ill patients have an advance directive in their medical record, and physicians are accurate only about 65% of the time when predicting patient preferences for intensive care. Decision aids can support the advance care planning process by providing a structured approach to informing patients about care options and prompting them to document and communicate their preferences.
This review, commissioned as a technical brief by the Agency for Healthcare Research and Quality Effective Health Care Program, provides a broad overview of current use of and research related to decision aids for adult advance care planning. Using interviews of key informants and a search of the gray and published literature from January 1990 to May 2014, the authors found that many decision aids are widely available but are not assessed in the empirical literature. The 16 published studies testing decision aids as interventions for adult advance care planning found that most are proprietary or not publicly available. Some are constructed for the general population, whereas others address disease-specific conditions that have more predictable end-of-life scenarios and, therefore, more discrete choices. New decision aids should be designed that are responsive to diverse philosophical perspectives and flexible enough to change as patients gain experience with their personal illness courses. Future efforts should include further research, training of advance care planning facilitators, dissemination and access, and tapping potential opportunities in social media or other technologies.
Continuum of health states during which advance care planning may be considered.
Appendix Table 1. Interview Probes for Key Informants
Appendix Table 2. MEDLINE Search Strategy
Table 1. Examples of General Advance Care Planning Decision Aids Publicly Available on the Internet
Table 2. Examples of Advance Care Planning Decision Aids Publicly Available on the Internet for Persons With Serious or Advanced Illness
Table 3. Outcomes Assessed in Studies of Advance Care Planning Decision Aids
Appendix Table 3. Studies of Advance Care Planning Decision Aids
Table 4. Advance Care Planning Decision Aids Described by Using the IPDAS Criteria
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Mary Butler, Edward Ratner, Ellen McCreedy, Nathan Shippee, Robert L. Kane. Decision Aids for Advance Care Planning: An Overview of the State of the Science. Ann Intern Med. 2014;161:408–418. doi: 10.7326/M14-0644
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Published: Ann Intern Med. 2014;161(6):408-418.
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