Empowering Your Healthcare Journey

Empowering Your Healthcare Journey:
The Evolution and Importance of Advance Care Planning

In an era where individuals increasingly expect a level of control over every facet of their lives, healthcare is no exception. Professionals in medical and behavioral care understand better than anyone the importance of respecting and honoring the deeply personal wishes of those experiencing a health crisis or emergency. Patients today are not merely passive recipients of care. They want to actively partner with their care teams in shaping their healthcare journey. This shift underscores the critical need for robust, accessible, and personalized advance care planning (ACP).

Understanding the Evolution of Advance Care Planning

To appreciate where we are today, let’s take a look back at the evolution of ACP:

• 1st Generation (1960s-1980s): The introduction of living wills, powers of attorney for healthcare, Do-Not-Resuscitate orders, and psychiatric advance directives (now more commonly called mental health advance directives) laid the groundwork for patient autonomy in healthcare decisions. These tools, still in use today, allowed individuals to express their wishes regarding a few time-sensitive elements of emergency or end-of-life care.
• 2nd Generation (1989-1990): This era saw a divergence in approach with the creation of technical (medical and mental health advance directives) and personal (values and preference-based) forms. These documents aimed to capture both the medical and personal aspects of a person's healthcare wishes.
• 3rd Generation (Mid-1990s): The Five Wishes document emerged, blending the technical and personal aspects of ACP. Five Wishes emphasizes the importance of both medical directives and personal values when creating advance healthcare directive forms.
• 4th Generation (1995-Present): Actionable practitioner orders such as POLST, MOST, and MOLST were created, making it easier for healthcare providers to impact care delivery and honor a patient's wishes across different care settings.

Which brings us to present day. Rebecca Sudore, MD, a respected researcher and leader in advance care planning succinctly defines ACP as "a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care." Seems simple enough, and a concept we can all get behind.

So, how do healthcare and behavioral health providers and partners in care maintain the trust that our patients place in us? The key lies in ensuring patient preferences for treatment are not only documented, and stored in their clinical record, but are also easily accessible to all providers and care team members whenever and wherever they are needed.

Building and Maintaining Trust in the Patient-Provider Relationship

In medical and behavioral healthcare, trust is the cornerstone of the patient-provider relationship. To maintain and strengthen this trust, it's essential to ensure that patients' preferences are not only documented and kept updated but are also readily accessible and actionable to others who would treat our patients due to a health crisis or emergency when needed. This kind of access and approach to ensure the trust patients have placed in healthcare providers is demonstrated requires a seamless availability of ACP documents of all types across the broader care continuum.

Leveraging Technology to Streamline Care and Enhance Patient Outcomes

The healthcare landscape is rife with repetitive, time-consuming tasks that can pull clinicians and care teams away from a personalized level of patient care to a more standardized care delivery approach. By embracing technology, we can automate many of these time-consuming processes, thereby allowing providers to focus on what truly matters to their patients: delivering compassionate, personalized care.

A well-structured ACP process helps providers locate ACP documents when they need them most urgently and should include:

• Comprehensive Documentation: At the time of intake or admission, the provider should inquire whether the patient has existing ACP documents. If they do, the provider should be sure to collect and carefully review the documents with the patient and/or their healthcare agent to ensure they align with the patient’s current values and preferences for treatment. It’s crucial to keep these documents updated, reflecting       changes in the patient's wishes or preferences for the care they do or do not want to receive, as those can change over time.
• Accurate Record Keeping: The patient’s chart or electronic health record should include copies of their ACP documents with key elements highlighted in their record that can become time-sensitive such as CPR status, designated healthcare agents and their contact information, and any specific treatment preferences.

• Visibility Across the Care Team: It’s essential that this information be easily accessible to every member of the care team within the organization, and that everyone is aware of what has been captured in the patient’s ACP documents. Digital systems are particularly effective in providing quick reference points, as well as more detailed information, within easy reach when it is urgently needed.

• Broad Access and Sharing: Providers should ensure the patient’s ACP documents are available not only to the immediate care team but also to others those patients will encounter during their healthcare journey. This might include family members and friends but should also include other healthcare providers across the care continuum. This information should also be available beyond a specific care location to ensure it can be easily found by other medical teams to facilitate in-the-moment treatment decisions. This is accomplished through electronic health records, state health information exchanges, their patient portals, or any others secure digital platforms, such as personal health record systems or large-scale registries of ACP documents.

The Imperative of Digital Advance Care Planning

Given the complexity of today’s healthcare and the pressures that are mounting to maximize reimbursement, quality, and outcomes while minimizing risk all in the same decision-making moment, the shift to digital ACP document creation and access is not just a convenience – it’s a necessity. Here’s why digital ACP systems are critical for all adults and their providers:

• Portability and Accessibility: Digital ACP documents can seamlessly follow the patient across different care settings, ensuring that their wishes are respected no matter where they receive care. This eliminates the risks associated with paper forms, which can be misplaced or inaccessible in a crisis and tangibly demonstrates commitment to the patient even when they are being treated by other medical teams, thereby restoring trust in the providers and potentially the larger healthcare delivery system.
• Verification and Authentication: Digital systems provide a clear audit trail that reduces risk by verifying who created the document, when it was signed, which version is current, and who has accessed it. This enhances the authenticity and reliability of the documents, which increases the confidence of the provider using them to inform treatment.
• Interoperability and Integration: Digital ACP documents can be securely yet easily made available across different providers, healthcare systems, health information networks, and with trusted individuals, ensuring that everyone is working from the most current version of information. This is particularly important in complex care environments where multiple providers may be involved in a patient’s care and for those who experience behavioral health crises at the same time they are having a medical emergency.

Creating a Personalized Healthcare Experience

Healthcare providers are not only leaders within their area of care, but they’re also consumers of healthcare. As such, a provider’s mission should be to deliver care that is not only clinically sound but also deeply personalized. Modernizing advance care planning through digital solutions is a crucial step in achieving this goal. By ensuring that every individual’s medical and behavioral health journey is guided by their values, preferences, and goals of care, providers can be part of creating a more compassionate, patient-centered care healthcare system.

Conclusion

The evolution of ACP document options reflects a foundational shift toward patient-centered care, where individuals are empowered to shape their medical and behavioral health journey. For providers, embracing digital ACP systems is not just about keeping pace with technology; it’s about ensuring that every individual’s voice is heard and respected, especially in their most vulnerable moments. By integrating these modernized approaches to personalized care into the organization, providers can build stronger patient and family member relationships, improve the outcomes of care, and provide the highest standard of compassionate care.