Health Providers Need to Stress?importance of Advance Care Planning

By Bishop, Beverly | The Buffalo News (Buffalo, NY), September 23, 2012 | Go to article overview

Health Providers Need to Stress?importance of Advance Care Planning


Bishop, Beverly, The Buffalo News (Buffalo, NY)


The Patient Self Determination Act, which took effect in 1991, requires that all patients receive information on advance directives upon admission into hospitals or long-term care facilities that receive Medicare or Medicaid funding. Past research has shown that there is still a need for improvement, particularly in the advance care planning discussion that takes place between health care providers and patients and their families. To do this requires educating the public and health care providers on the importance of advance care planning.

As a doctor of nursing practice student in the Public Health Nursing Leadership program at the University of Massachusetts, I feel it is imperative that we improve educational initiatives and health care policy to institute such changes and promote understanding and use of advance care planning.

It is essential that conversations continue, which is not only the role of the physician, but of advance practice nurses as well. As an oncology nurse, I understand the importance of patients' personal, cultural and spiritual preferences, as well as their goals of care. I've also seen many instances where no advance directives were in place during a critical point in care.

Health care reform initially attempted to address advance care planning discussions between physicians and patients by allowing physician reimbursement under Medicare coverage. However, this provision was removed from the early version of the Patient Protection and Affordable Care Act in 2009, when Sarah Palin grouped this provision into her "death panel" arguments that any such discussion would allow physicians to have judgment on who was worthy of care.

Unfortunately, it appears this mindset has stuck for many because revisions were again excluded from legislation. It is important to understand that advance care planning discussions do not only have to take place with ill individuals. While these provisions would have allowed for reimbursement of the time spent on discussion, they do not prohibit health care providers from having these discussions with patients and their families.

While advance directives are given upon admission into a health care facility, the topic is usually put aside until an emergency arises, such as a change in health and/or mental status. The Agency for Healthcare Research and Quality states that less than 50 percent of severely or terminally ill patients have an advance directive in their medical record, and that only 12 percent of patients who have a directive received any input from their physician. …

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Health Providers Need to Stress?importance of Advance Care Planning
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