Approximately 40 percent of Americans over the age of 65 do not have advanced directives or written end-of-life (EOL) wishes related to medical treatment. Even when these documents exist, they are often ineffective due to ambiguity or incompleteness. As of January 2016, Medicare covers advanced care planning services provided by qualified healthcare providers. This policy change is meant to ensure the delivery of patient-centered care in the event a patient is unable to speak for his- or herself. While there is broad public support for this policy change, no quality metrics and standards for clinician–patient communication related to end-of-life care have been established.
Our aim is to build relationships between older adults (patients and caregivers), providers, and researchers around what meaningful EOL clinician–patient communication looks like. We will continue to engage older adults, providers, and local researchers who serve on our advisory group to participate in a learning community to build a shared understanding about how clinician–patient communication and shared planning can be improved, and to generate ideas for system changes that can be evaluated with a future PCORI research project. In addition, we will hold five roundtables of four to eight people from diverse populations to learn more about their thoughts as related to advance care planning.