How to Improve Advanced Care Planning for Patients and Caregivers

In recognition of “National Healthcare Decisions Day,” the “PREPARE for Your Care” program at UC San Francisco is making it easier for clinicians to remind their patients of the importance of planning for their medical care and preparing for medical decision-making. The program provides easy-to-use tools for patients, caregivers, and clinicians.

Millions of older adults and their caregivers face medically and emotionally complex decisions, yet many are unprepared. This lack of preparation often leads to uninformed decisions and care that can be inconsistent with personal preferences. Over time, this can result in dissatisfaction with medical care and increase caregiver burden and distress.

Advance care planning (ACP) is a process that prepares patients and surrogate decision-makers for informed medical decision-making. Most patients say ACP is important and they would like their medical providers to talk with them about it, yet relatively few have had meaningful conversations about their health care preferences.

"It is important to remember that medical planning is for everyone at every age and at every stage of health,” said Rebecca Sudore, MD, a geriatrician, palliative medicine physician, and UCSF professor of medicine. “It is not just about end-of-life, but how people want to live and what is important to their quality of life and their medical care right now."

Sudore has spent over two decades working with patients, caregivers, clinicians, and communities to improve ACP. The result is the PREPARE for Your Care Program, one of the nation’s leading multilingual, evidence-based ACP programs and the only patient-directed ACP program endorsed by the National Council on Aging. It walks patients and caregivers through preparing for medical decision-making step by step and offers easy-to-read, values-based advance directives to designate a surrogate decision-maker and record preferences about quality of life and medical care.

The program includes provider tools to make ACP more accessible and actionable in everyday clinical practice. For example, it has “simple scripts” with words clinicians can use to start brief conversations, as well as handouts they can share with patients. In addition, it offers facilitator guides for planning group medical visits or community events.

In randomized trials of English and Spanish-speaking adults, the program helped 98% of participants engage in ACP — such as having a conversation, designating a surrogate, or completing an advance directive — and increased ACP documentation in the medical record from 8% to 43%. It also primed patients for clinical visits, making things easier on clinicians, and increased self-reported goal-concordant care.

"Our research has demonstrated that the program gives people the tools to have a voice in their health care, to talk with their family and friends and medical providers about what is most important to them, and to get the medical care that is right for them,” said Sudore.

The PREPARE for Your Care Program is free nationally for personal use. UCSF also offers opportunities for organizations to customize and integrate the program’s tools into their processes.

About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is highly-ranked hospital, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland; two community hospitals, UCSF Health Stanyan and UCSF Health Hyde; Langley Porter Psychiatric Hospital; UCSF Benioff Children’s Physicians; and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit www.ucsfhealth.org. Follow UCSF Health on Facebook or on Twitter.