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Invited Commentary
July 2014

What Should Be the Goal of Advance Care Planning?

Author Affiliations
  • 1Department of Medicine, Section of Palliative Care and Medical Ethics, 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
JAMA Intern Med. 2014;174(7):1093-1094. doi:10.1001/jamainternmed.2014.1887

The systematic review by Auriemma et al1 provides a valuable synthesis of the evidence on stability of end-of-life (EOL) treatment preferences. Among 24 longitudinal studies included in quantitative analysis, they found that in most (17 of 24), more than 70% of patients’ preferences for EOL care were stable over periods ranging from weeks to years. The results suggest a greater degree of preference stability among inpatients and seriously ill outpatients than among older adults without serious illness (although the former groups were assessed over shorter time periods), as well as a higher rate of stable preferences among patients who have engaged in advance care planning. The authors are careful not to overinterpret these results, noting the heterogeneity in studies precluding meta-analytic estimates, the use of hypothetical rather than “real world” scenarios, and the significant minority of patients who change their preferences for future treatment over time. However, they conclude that EOL preferences are generally stable, particularly among patients for whom advance directives may be most beneficial.