Waning Pandemic May Mean Less Interest in Advance Care Planning

By Jonathan Springston, Editor, Relias Media

In conjunction with National Healthcare Decisions Day, held each year on April 16, VITAS Healthcare, a hospice and palliative care provider, commissioned a survey that indicates Americans may not be as willing to discuss advance care planning now compared to one year ago.

The COVID-19 pandemic shocked many in understanding the fragility of life and the importance of putting advance care plans in writing. However, according to the results of the VITAS survey, in 2021, 29% of Americans reported the pandemic raised the likelihood they would discuss documenting their end-of-life care wishes. This year, that dropped to 22.5%. In 2022, 35.4% have documented their wishes compared to 32% in 2021. This appears promising until one considers not many have taken meaningful actions to back their beliefs — the survey indicates 68% respondents consider documenting end-of-life care is important or very important, and 55% have at least discussed the matter with someone.

“The pandemic has, unfortunately, brought death to the doorsteps of many Americans. Compared to 2021, we see that more people report having documented their end-of-life wishes, which is a positive sign,” Joseph Shega, MD, VITAS executive vice president and chief medical officer, said in a statement. “However, we are also seeing a decline in indication that those who have not yet documented their plans will do so, possibly tied to a COVID-19 reprieve on the horizon. Seeing this, I can’t overstate the importance of advance care planning and advance directives. Advance care planning allows patients to make their preferences known early, and knowing a patient’s wishes for end-of-life care ensures care aligns with their goals and values while also relieving the burden on families to make critical medical decisions on behalf of their loved ones.”

A 2018 report indicated while 99% of physicians believe end-of-life care planning is important, only 29% reported receiving formal training. This summer, VITAS says it will launch a preceptorship and certificate program at the National Black Nurses Association Annual Conference. The program will include prognostication, hospice basics, and how to start the advance care planning conversation. It also includes practice scenarios where participants can hear feedback on real conversations with patients.

“Clinicians play an important role in starting advanced care planning conversations with patients and families,” Martha Dawson, MD, FACHE, president and CEO of the National Black Nurses Association, said. “There is a need for more resources to help clinicians have these crucial conversations, especially with Black and other racially diverse patients and families who often face barriers and poor access to care. Using an approach that empathizes, informs, and genuinely seeks to understand a patient’s wishes can assist in creating peace of mind for families and patients. It also eases the burden of healthcare workers when offering emotional support. This new novel, positive approach will ensure equity in advance care planning for all populations.”

As the National Hospice and Palliative Care Organization (NHPCO) explains, advance care planning means completing an advance directive (perhaps better known as a living will) and appointing a healthcare power of attorney (i.e., a person who makes healthcare decisions for someone else if decision-making capacity is lost). All this information should be shared verbally and in writing with loved ones. NHPCO offers much more information on this process here.