Chronic Illness and Advance Care Planning - What's Taking Us So Long to Get it Right?

It seems like such a simple thing--asking patients and families what they understand and what they hear when their healthcare is discussed. Despite the simplicity, and even ease, with which a practitioner can check out the perspective of a patient or family member, it just isn't done that often. Moreover, comprehensive advance care plans that document agreement among the patient, significant other(s), and the health care team about how to respond to the anticipated complications of a chronic illness, are rare.
Respecting Choices, the best practice Advance Care Planning initiative of Gundersen Lutheran Medical Foundation, has developed an interview tool that promises to dramatically increase patient, family, and healthcare provider satisfaction as it pertains to the management of chronic illness. This interview is delivered by clinicians certified in the Disease Specific/Patient Centered Advance Care Planning (DSPCACP)intervention. Research at Gundersen Lutheran has demonstrated the efficacy of this intervention on a number of levels.
Key features of the interview include:
1. 1.5 hour interview with patient and healthcare agent in outpatient setting
2. Assessment of dyad’s understanding of illness
3. Structured interview that integrates replicable communication techniques
A randomized control study(312 dyads--patients and their family members with end stage renal disease and congestive heart failure)has demonstrated that the DSPCACP significantly increases family members' congruence with patient wishes. One dyadic group received usual advance care planning support and the other received the interview intervention. The DSPCACP group had decreased difficulty in making decisions for future healthcare. There was no difference in anxiety between the two groups. Data are currently being tabulated on the increased likelihood of the patients' wishes being followed at time of death.
I'm excited about what the DSPCACP intervention offers in the field of Advance Care Planning. It's a giant step forward and I believe that its use will change how healthcare providers deliver care to patients (and significant others)with chronic illness.
Way back in 2003, an article by Joanne Lynn and Nathan Goldstein: Advance Care Planning for Fatal Chronic Illness: Avoiding Commonplace Errors and Unwarranted Suffering, chronicles the need for a tool such as the DSPCACP interview. Why, after 5 years, aren't we moving forward faster?