Improving Medical-Legal Advance Care Planning

• Published in: Journal of pain and symptom management Vol. 60; no. 2; pp. 487 - 494
• Main Authors: Hooper, Sarah, Sabatino, Charles P., Sudore, Rebecca L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2020; Elsevier Limited
• Subjects: Advance care planning; Advance directives; Attorneys; Care plans; Health care; Interdisciplinary aspects; interprofessional; law; Legal medicine; Medical prognosis; Mental competency; Palliative care; Patients; workforce; Advance care planning; workforce; law; advance directives; interprofessional
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2020.03.004

The importance of advance care planning (ACP) has been increasingly recognized by health systems. However, 46%–76% of patients report engaging in ACP with lawyers, whereas only a minority report doing so with physicians. In the U.S., ACP with lawyers focuses on advance directive documents, naturally occurs outside of health care contexts, and is often uninformed by the clinical context, such as one's prognosis and clinical trajectory. These forms are regularly stored at home or at a lawyer's office and not available at the bedside when needed in a medical crisis. Yet, in contrast to clinicians, lawyers hold sophisticated knowledge about their states' advance directive law. Lawyers may also understand clients' socioeconomic context and plans more broadly, which are known to be critical for contextualizing and personalizing patient care but are often not well captured in health care. Aligning medical and legal approaches to ACP is important to ensuring the quality and value of those efforts. As an important first step toward this goal, we convened an interprofessional panel of medical and legal experts to elucidate the state of medical-legal ACP and begin to identify strategies to improve and align practices within and across professions. This article describes the historical disconnects between the medical and legal practice of ACP, recommendations and products of the interprofessional panel, and recommendations for future medical-legal collaboration.