Advance care planning.

Abstract

Advance care planning is important; the discussion should start early, prior to a life-threatening illness and repeated as necessary when there are changes in a patient's status. It is not necessarily the final document that is important, but the communication that occurs during the process of ACP. It is during the discussion the physician and family will learn about and understand the patient's wishes. As Teno commented, "Even the most detailed written directive is likely to be of limited value if there has been no communication among patient, provider team, and proxy decision-maker." If an advance directive document is not completed, the wishes of the patient must be documented in the medical record. We know from the 2005 South Dakota "Dying to Know" survey that only 35 percent of South Dakotans have completed an advance directive and 39 percent want their physicians to initiate the conversation. South Dakota physicians can take an active role in increasing these percentages by initiating the advance directive discussion with their patients and completing their own directives. We can help our patients realize that the discussion of their values at end of life is a natural part of caring for themselves and their family.