An approach to advance care planning in the office.

OBJECTIVE: To outline how advance care planning is a process of communication among patients, their families, and health care providers regarding appropriate care for patients when they are no longer able to make decisions for themselves. SOURCES OF INFORMATION: Level I evidence supports systematic implementation of advance care planning under controlled circumstances, such as in institutions. Level II evidence supports exploring factors that determine treatment preferences and change treatment preferences and other factors that complicate the process of end-of-life decision making. Level III evidence supports the approach to advance care planning in the office described in this article. MAIN MESSAGE: Family physicians can help prevent the suffering of patients with chronic illnesses by facilitating discussion of end-of-life issues. The approach suggested in this article will help reduce avoidance of the issues and minimize the difficulty of discussing issues crucial to patients and their families.
CONCLUSION: Advance care planning can prevent suffering and enable patients to receive care congruent with their goals at the end of their lives. Family physicians can be key to facilitating this process.