Should We Shift from Advance Care Planning to Serious Illness Communication?

There is a lively debate going on in academic circles about the value of Advance Care Planning (ACP).  It’s not a new debate but has gathered steam at least in palliative care circles since Sean Morrisons published a JPM article titled “Advance Directives/Care Planning: Clear, Simple, and Wrong.”  Since then there has been a lot of back and forth, with even a couple of podcasts from us, several JAMA viewpoints, and most recently a series of published replies from leaders in the field on why ACP is still valuable (see below for references).   Despite all of these publications, I’m still left at a loss of what to think about it all.  Most of the debate seems rather wonky, as honestly it feels like we are getting stuck in the weeds of semantics and definitions, like what counts as ACP versus in the moment decisions.  But the consequences are real, from research funding dollars to health systems investment.  

So in today's podcast, we have invited Juliet Jacobsen and Rachelle Bernacki to talk about what all the fuss is about.  Juliet and Rachelle are two of the authors of a recent JAMA viewpoint titled “Shifting to Serious Illness Communication.”  

We discuss the debate, how to think about definitions of ACP vs serious illness communication, what should go into high quality conversations, the evidence for and against any of this, and ultimately where we go from here.   

Also see the image from Alex’s forthcoming editorial in JAGS, a Venn diagram of advance care planning and serious illness communication (please go to GeriPal.org to view the image).

So check out the podcast and if you are interested in diving into this debate, here are some great links to learn more:

• What’s Wrong With Advance Care Planning? JAMA 2021

• Controversies About Advance Care Planning. JAMA 2022 (a reply to the above)

• Shifting to Serious Illness Communication. JAMA 2022

• Our podcast with Sean Morrison titled “Advance Care Planning is Wrong”

• Our podcast with Rebecca Sudore and Ryan McMahan titled “Advance Care Planning is So Right”

• Our podcast with Rachelle Bernacki and Jo Paladino on the Serious Illness Conversation Guide