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Documents for advance care planning
What are some of the documents used in advance care planning?
There are many documents beyond the Do Not Resuscitate form that may be useful for ACP. Some of these include physician orders for life-sustaining treatment, Five Wishes, and state- or institution-specific advance healthcare directives.
The below table provides an overview of the purpose of many of these forms. Reviews of useful advance directives, as well as their limitations, are available in the literature (Holley JL, Clin J Am Soc Nephro , 2012).
Advance Directives
| TYPE | DESCRIPTION OR PURPOSE |
|---|---|
| Generic advance directive or “living will” | A document of variable length, specificity, and interpretability that aims to clarify a patient’s preferences about medical therapies and/or end-of-life care. |
| Declaration of surrogate decision-maker | Identifies an adult individual who can make healthcare decisions for the patient when he/she is unable to do so. |
| Physician Orders for Life Sustaining Treatment (POLST) | An actual physician signed order that outlines a patient’s care goals, including code status and preferences for life-sustaining treatments. Because POLST forms are a translation of a patient’s goals and preferences into an order, they are less ambiguous than some typical advance directive documents. POLST forms are available in most states and document names will differ by state. |
| Do not resuscitate (DNR) | A physician order (sometimes with patient co-signature) that prohibits initiation of cardiopulmonary resuscitation in the event of cardiac arrest. A patient who elects a DNR plan of care is still able to receive curative therapies such as invasive procedures, intensive care unit care, chemotherapy, mechanical ventilation, or dialysis. |
To maintain broad applicability, general terminology is used. There is state-level variability in terminology and legal differences exist throughout the United States.
