Advance Care Planning in Terminal Illness: A Descriptive Pilot Study

Abstract

Though the Agency for Healthcare Research and Quality (AHRQ, 2003) considers

advance care planning as “preferences for care at the end of life”, review of the

literature shows that advance care planning is more complex than this. As

preferences for care at the end of life include treatment choices and decision-

making which require thorough patient understanding, vital components entail

patient advocacy, advance directives, alternative treatment, collaboration of care,

coordination of care, cultural sensitivity, do not resuscitate orders (DNRs),

decision-making, effective communication, ethics, holistic practice, “illness

awareness” (Corli et al., 2009), living wills, patient rights, power of attorney, illness

prognostic discussions, and truth-telling. Since the AHRQ (2008) has healthcare

practice guidelines that state that physicians should conduct advance care

planning yearly with their patients, implications for the nurse practitioner are

perfecting role preparedness as increasing autonomy and responsibilities of the

profession are projected on provisions for healthcare coverage (i.e. primary care,

cancer care, and geriatrics). The primary goal for advance care planning in

terminal illness is to improve patient/family outcomes, and the nurse practitioner is

holistically prepared to conduct early and regular discussions of advance care

planning with patients and families when prognoses are poor, treatment fails, or

disease recurs.

Method. In a pilot study of 30 nurse practitioner participants in the Atlanta and

surrounding area, greater insight into communication strategies, tools, and role

preparedness of the nurse practitioner on advance care planning in terminal illness

is sought. For thorough sampling, three random practices types are selected:

internal medicine, oncology, and pulmonary care.

Keywords: communication, end-of-life, prognosis, advance care planning,

terminal illness