Advance care planning (ACP) is the process by which older adults can plan for their future medical care in preparation for a time of decisional incapacity. ACP involves three main activities: communication between the patient and their loved ones about their goals of care, the assignment of a trusted person as a surrogate decision-maker, and documentation of medical preferences in the health record. Despite increased engagement in ACP, a study found that still only a third of U.S. adults had completed ACP between 2011 and 2016.
With funding by the National Institute of Nursing Research and the National Institute of Aging, Terri Fried, MD, section chief (geriatrics) and professor of medicine (geriatrics) and her colleagues evaluated the efficacy of the Sharing and Talking About My Preferences (STAMP) intervention to encourage more adults to complete ACP. Fried and her colleagues published their findings on August 31 in the Annals of Internal Medicine. The STAMP Intervention consists of a brief assessment about the individual’s readiness to change and attitudes toward advance care planning followed by feedback reports with individualized information and suggested next steps, as well as personalized brochures.
Compared to other studies which defined ACP engagement as completion of only one of its three components, Fried’s study defined engagement as the completion of all three. Furthermore, Fried’s study was designed to reach as broad a spectrum of the population as possible, using the phone to reach older adults who don’t have access to or use the internet.
Fried found an absolute difference of 5 percentage points in the number of individuals completing ACP in the intervention compared to the control population. “While this difference may seem small, the fact that the intervention can be delivered to large groups of people can result in truly meaningful increases in ACP engagement on a population level.”
The intervention can be delivered by nurses, care managers, or anyone in the practice who already uses telephone follow up calls or chronic disease management. “Our hope is that by having individuals start engagement in ACP earlier, they may be more prepared to face difficult decisions as they come along. The expectation is that this will result in greater efficiency when the physician’s time is needed.”
Yale’s Section of Geriatrics strives to improve the health of older adults by providing exceptional patient care, training future leaders and innovators in aging, and engaging in cutting-edge research. To learn more about their mission, visit Geriatrics.