ReviewJournal of general internal medicine2012
The need for safeguards in advance care planning.
Review in Journal of general internal medicine, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 44 citations in OpenAlex.
- Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations.Palliative medicine · 2016Pooled it
- Advance care planning and end-of-life decision making in dialysis: a randomized controlled trial targeting patients and their surrogates.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2015Trial
- Life-sustaining treatment preferences: matches and mismatches between patients' preferences and clinicians' perceptions.Journal of pain and symptom management · 2013Trial
- Public Health Challenges and Responses to the Growing Ageing Populations.Public health challenges · 2024Review
- Forms or Free-Text? Measuring Advance Care Planning Activity Using Electronic Health Records.Journal of pain and symptom management · 2023Review
- Perceptions of Patients and Their Families Regarding Limitation of Therapeutic Effort in the Intensive Care Unit.Journal of clinical medicine · 2021Article
- Enhancing Advance Care Planning Communication: An Interactive Workshop With Role-Play for Students and Primary Care Clinicians.MedEdPORTAL : the journal of teaching and learning resources · 2020Article
- Article
- Acceptability of Paper-Based Advance Care Planning (ACP) to Inform End-of-Life Care Provision for Community Dwelling Older Adults: A Qualitative Interview Study.Geriatrics (Basel, Switzerland) · 2018Article
- New frontier: cancer pain management clinical fellowship.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2018Article
- The Voice Is As Mighty As the Pen: Integrating Conversations into Advance Care Planning.Journal of bioethical inquiry · 2018Review
- Development and psychometric evaluation of the Decisional Engagement Scale (DES-10): A patient-reported psychosocial survey for quality cancer care.Psychological assessment · 2016Article
- Improving End-of-Life Decision-Making About Resuscitation and Intubation.Journal of general internal medicine · 2015Article
- Understanding how cancer patients actualise, relinquish, and reject advance care planning: implications for practice.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2013Article
- Advance care planning safeguards.Journal of general internal medicine · 2012Article
- Determining compound comorbidities for heart failure from hospital discharge data.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2012Article
Corrections and comments
- Commented on by
Authors and funding
1 author at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The recent uproar about Medicare "death panels" draws attention to public and professional concerns that advance care planning might restrict access to desired life-sustaining care. The primary goal of advance care planning is to promote the autonomy of a decisionally incapacitated patient when choices about life-sustaining treatments are encountered, but the safety of this procedure has not received deserved scrutiny. Patients often do not understand their decisions or they may change their mind without changing their advance care directives. Likewise, concordance between patients' wishes and the understanding of the physicians and surrogate decision makers who need to represent these wishes is disappointingly poor. A few recent reports show encouraging outcomes from advance care planning, but most studies indicate that the procedure is ineffective in protecting patients from unwanted treatments and may even undermine autonomy by leading to choices that do not reflect patient values, goals, and preferences. Safeguards for advance care planning should be put in place, such as encouraging physicians to err on the side of preserving life when advance care directives are unclear, requiring a trained advisor to review non-emergent patient choices to limit life-sustaining treatment, training of clinicians in conducting such conversations, and structured discussion formats that first address values and goals rather than particular life-sustaining procedures. Key targets for research include: how to improve completion rates for person wanting advance care directives, especially among minorities; more effective and standardized approaches to advance care planning discussions, including how best to present prognostic information to patients; methods for training clinicians and others to assist patients in this process; and systems for assuring that directives are available and up-to-date.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.