Definition for Research
While ACP consisted of common elements, no formal definition existed to guide clinical application, medical billing practices, research studies, intervention development, or legal and policy initiatives. Recently, a large panel of multidisciplinary international ACP experts were identified to develop a unifying definition. Through several rounds of using the Delphi method and multiple edits, the multidisciplinary panel reached consensus on an ACP definition statement which reads (Sudore et al., 2017):
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Consensus definition of advance care planning for adults
Definition statement
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Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care.
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The goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness.
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For many people, this process may include choosing and preparing another trusted person or persons to make medical decisions in the event the person can no longer make his or her own decisions (p. 826).
The definition statement continued incorporating strategies to support adults in the advance care planning process such as on-going communication between patient, provider, and surrogate with a focus on health care goals, informed decision-making, identifying surrogate decision-makers, recording patient wishes, and saving the records where they can be located when needed (Sudore et al., 2017).
Furthermore, some of the same panel members worked on an ACP definition with international consensus and support from the European Association for Palliative Care. This panel contained 109 ACP experts from Europe, Australia, and the United States. While the wording is a bit different, the central element is the same: “ACP is considered to be a process that includes the identification of values and defining goals and preferences for future medical treatment and care and discussion of these factors with the patient’s family and health-care providers” (Rietjens et al., 2017, p. e546). Other key elements in the international definition were regular review, documentation, selection of surrogates, and inclusion of all with decisional capacity (Rietjens et al., 2017). These two definitions clearly reflect the shift from AD completion to a multistep ACP process, will guide future research, and will identify universal outcomes to facilitate program improvements and generate replicable research studies.