TOO MANY OPTIONS AND NO DIRECTION: LESSONS LEARNED FROM A REVIEW OF ADVANCE CARE PLANNING OPTIONS

摘要

Since the adoption of the first living will in 1976, Advance Care Planning (ACP) documents have proliferated across the United States. The growth of ACP documentation has resulted in a patchwork of laws and procedures governing their use. ACP documents have also increased in complexity, resulting in confusion among users and practitioners. To better understand how to increase ACP usage in South Carolina, a state where those over age 65+ will double by 2030; we completed an assessment of practices within the state compared to best-practices from the literature. We completed a literature review of Advance Care Planning across multiple indexing databases in Summer of 2017. A total of 2,322 articles were identified. Upon review with selection criteria and removal of duplicates a total of 54 articles remained. Results of the literature review pointed to six broad themes for consideration: Managing Indicators Use; Interventions to Increase Use; ACP Documentation Types; Legislative Action; Communication and Marketing; and Tailored Messaging for Diverse Populations. From this review, we identified ten best practices for the management and increased uptake in ACP. Comparing the identified best-practices to systems currently in place within South Carolina resulted in five substantive opportunities that are preventing ACP in South Carolina from reaching its full potential. The identified best-practices and opportunities for improvement point towards a need to rethink how we approach ACP in the aging community and how we can ensure adequate use of these legal tools.