Muristek
To the Editor We have grave concerns about the advance care planning (ACP) evidence review and policy implications presented in the recent Viewpoint, which concluded that ACP is not essential because it does not support goal-concordant end-of-life (EOL) care. First, the authors misrepresented the conclusions of the 2 major review articles that formed the foundation of their argument. Indeed, the 2018 review concluded that ACP provides several benefits, including “improved end-of-life communication, documentation of care preferences, dying in preferred place, and health care savings,” and the 2020 review concluded that “outcomes for all ACP interventions were predominantly positive.” For example, 1 study found that knowledge of EOL wishes increased from 30% to 86% in the control vs ACP intervention group, and family members from the ACP intervention group had significantly less stress, anxiety, and depression compared with those from the control group. Moreover, the 5 additional randomized clinical trials (RCTs) cited in the Viewpoint contained significant limitations; 2 studies were performed outside the US with differing cultural and societal norms, most studies had low or less-than-ideal uptake of ACP interventions, and 1 study involved patients with advanced dementia who could not have meaningfully completed ACP with their proxies. After reviewing these studies, we therefore reached the different conclusion that ACP provides significant benefits for both patients and family members.
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