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March 17, 2015

Reengineering Advance Care Planning to Create Scalable, Patient- and Family-Centered Interventions

Author Affiliations
  • 1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 2Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 3Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA. 2015;313(11):1103-1104. doi:10.1001/jama.2015.0569

The Institute of Medicine (IOM) report Dying in America concluded that patients near the end of life often receive undesired, burdensome treatments and called for improvements in advance care planning to ensure that patients’ values guide medical care.1 There is no clear path to accomplish this because there are major shortcomings to existing advance care planning. First, traditional advance directives are often narrowly focused on treatment preferences that are difficult to apply in many clinical situations. The second approach, facilitated advance care planning, is resource intensive and thus difficult to scale up to meet increasing demand. In this Viewpoint, we propose 2 interrelated strategies to create the next generation of advance care planning tools: (1) leveraging web-based technologies to create online interventions and (2) using the science of user-centered design to ensure that advance care planning meets the needs of patients, families, and clinicians.