Timely and efficient communication is an important prerequisite for appropriate care that adequately addresses patients’ needs and preferences. However, research findings consistently demonstrate that communication between physicians, patients, and their relatives is complex. Physicians are often uncertain about their patients’ values and preferences, and relatives may feel stressed, uncertain, and reluctant to relinquish treatment aimed at sustaining life, even if cure is no longer possible.
Advance care planning (ACP) is a formalized process of communication between patients, relatives and professional caregivers. It is a voluntary process of discussion and review enabling individuals to express, and, if they wish, record views, values and specific treatment choices to inform their future care. ACP promotes the documentation of patients’ preferences in their medical file, the communication of these preferences to family and friends, and the periodic review of preferences as circumstances change. It has the potential to empower patients, to foster autonomy, to improve the quality of decision making for patients and relatives, to increase the extent to which care is addressing patients’ needs and preferences, and to reduce patients’ symptom burden.
There has been a growing attention for advance care planning since the 1990’s. In the United States, the Patient Self Determination Act in 1991 embodied the use of advance directives to promote adequate communication. From the mid-nineties, ACP evolved from advance directives to a more comprehensive approach where filling in an advance directive is only one part of a process of communication. Modern ACP programs aim at informing and empowering patients to express their preferences about their current and future treatment.