Current Practices in Advance Care Planning

Discussions regarding advance care planning (ACP) among patients with cancer and their physicians largely are not happening. Many patients with cancer, even those at the end of life (EOL), have not established an advance directive (AD). Lack of EOL discussions and receipt of aggressive care at the EOL have resulted in poor health outcomes for patients. In contrast, EOL discussions and early palliative care resulted in positive health outcomes for patients with cancer. The purpose of this review is to determine the current practices of ACP between healthcare providers and their patients in the United States and the use of ADs, particularly among patients with cancer. In addition, the authors offer recommendations for nurses and nurse practitioners on how to assist patients in ACP and the establishment of ADs. Research studies from peer-reviewed journals and reports from professional associations and agencies in the United States, published from 2002-2011, were reviewed and summarized. Nurses and nurse practitioners are in key positions to help patients with ACP and establishing ADs. Education and training for nurses and nurse practitioners regarding ACP needs to continue, and more research on the nurse practitioner's role in ACP should be conducted.