Physicians’ Views on Advance Care Planning and End-of-Life Care Conversations.
Abstract
OBJECTIVES: To evaluate physicians' views on advance care planning, goals of care, and end-of-life conversations. DESIGN: Random sample telephone survey. SETTING: United States. PARTICIPANTS: Physicians (primary care specialists; pulmonology, cardiology, oncology subspecialists) actively practicing medicine and regularly seeing patients aged 65 and older (N=736; 81% male, 75% white, 66% aged ≥50. MEASUREMENTS: A 37-item telephone survey constructed by a professional polling group with national expert oversight measured attitudes and perceptions of barriers and facilitators to advance care planning. Summative data are presented here. RESULTS: Ninety-nine percent of participants agreed that it is important to have end-of-life conversations, yet only 29% reported that they have formal training for such conversations. Those most likely to have training included younger physicians and those caring for a racially and ethnically diverse population. Patient values and preferences were the strongest motivating factors in having advance care planning conversations, with 92% of participants rating it extremely important. Ninety-five percent of participants reported that they supported a new Medicare fee-for-service benefit reimbursing advance care planning. The biggest barrier mentioned was time availability. Other barriers included not wanting a patient to give up hope and feeling uncomfortable. CONCLUSION: With more than half of physicians reporting that they feel educationally unprepared, there medical school curricula need to be strengthened to ensure readiness for end-of-life conversations. Clinician barriers need to be addressed to meet the needs of older adults and families. Policies that focus on payment for quality should be evaluated at regular intervals to monitor their effect on advance care planning.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Clinicians identify multiple barriers to initiating ACP conversations in persons living with dementia, including unpredictable illness trajectory, uncertainty about the right time to commence ACP, lack of time, resources, and knowledge, discomfort with ACP discussions, and difficulty determining the decision-making capacity of the person living with dementia.
“Numerous factors have been identified by clinicians as barriers to initiating ACP conversations in PLwD including unpredictable illness trajectory; uncertainty about the right time to commence the ACP process [10–12]; lack of time, resources, and knowledge; discomfort with ACP discussions [8, 13]; and difficulty in determining the decision-making capacity of the PLwD [14].”
From Acceptability of the voice your values, an advance care planning intervention in persons living with mild dementia using videoconferencing technology (2022) · cites this paper as [13]
Cites
Detering, K. M., Hancock, A. D., Reade, M. C., & Silvester, W. (2010) · BMJ · doi:10.1136/bmj.c1345 · Cited by 2,332 · see citing works
Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices
Bernacki, R. E., & Block, S. D. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.5271 · Cited by 1,422 · see citing works
Advance Directives and Outcomes of Surrogate Decision Making before Death
Silveira, M. J., Kim, S. Y. H., & Langa, K. M. (2010) · New England Journal of Medicine · doi:10.1056/nejmsa0907901 · Cited by 1,298 · see citing works
Dying in America: improving quality and honoring individual preferences near the end of life
(2015) · Choice Reviews Online · doi:10.5860/choice.191895 · Cited by 879 · see citing works
Mack, J. W., Weeks, J. C., Wright, A. A., Block, S. D., & Prigerson, H. G. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2009.25.4672 · Cited by 806 · see citing works
Systematic Review: The Effect on Surrogates of Making Treatment Decisions for Others
Wendler, D., & Rid, A. (2011) · Annals of Internal Medicine · doi:10.7326/0003-4819-154-5-201103010-00008 · Cited by 691 · see citing works
Bekelman, J. E., Halpern, S. D., Blankart, C. R., Bynum, J., Cohen, J., Fowler, R., Kaasa, S., Kwietniewski, L., Melberg, H. O., Onwuteaka-Philipsen, B. D., et al. (2016) · JAMA · doi:10.1001/jama.2015.18603 · Cited by 510 · see citing works
Sudore, R. L., Boscardin, W. J., Feuz, M. A., McMahan, R. D., Katen, M. T., & Barnes, D. E. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.1607 · Cited by 236 · see citing works
A Systematic Intervention To Improve Serious Illness Communication In Primary Care
Lakin, J. R., Koritsanszky, L. A., Cunningham, R. J., Maloney, F. L., Neal, B. J., Paladino, J., Palmor, M. C., Vogeli, C., Ferris, T. G. G., Block, S. D., et al. (2017) · Health Affairs · doi:10.1377/hlthaff.2017.0219 · Cited by 161 · see citing works
Improving Communication About Serious Illness in Primary Care
Lakin, J. R., Block, S. D., Billings, J. A., Koritsanszky, L. A., Cunningham, R. J., Wichmann, L., Harvey, D., Lamey, J., & Bernacki, R. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.3212 · Cited by 158 · see citing works
Abarshi, E., Echteld, M. A., Donker, G., den Block, L. V., Onwuteaka-Philipsen, B. D., & Deliëns, L. (2011) · Journal of Palliative Medicine · doi:10.1089/jpm.2010.0312 · Cited by 91 · see citing works
Recent Advances in Geriatrics: Drug-Related Problems in the Elderly
Hanlon, J. T., Shimp, L. A., & Semla, T. P. (2000) · Annals of Pharmacotherapy · doi:10.1345/aph.19140 · Cited by 65 · see citing works
Burkle, C. M., Mueller, P. S., Swetz, K. M., et al. (2012) · BMC Medical Ethics · doi:10.1186/1472-6939-13-31 · Cited by 48 · see citing works
Patient Perceptions on the Use of Advance Directives and Life Prolonging Technology
Clements, J. M. (2009) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909109331886 · Cited by 35 · see citing works
Koh, S.-J., Kim, S., Kim, J., et al. (2017) · Cancer Research and Treatment · doi:10.4143/crt.2016.446 · Cited by 35 · see citing works
Facilitators and barriers to advance care planning in oncology.
Paladino, J., Bernacki, R. E., Hutchings, M., et al. (2014) · Journal of Clinical Oncology · doi:10.1200/jco.2014.32.31_suppl.84 · Cited by 6 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
McMahan, R. D., Tellez, I., & Sudore, R. L. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16801 · Cited by 506 · see citing works
Palmer, M. K., Jacobson, M., & Enguidanos, S. (2021) · Health Affairs · doi:10.1377/hlthaff.2020.01895 · Cited by 61 · see citing works
Vellani, S., Puts, M., Iaboni, A., & McGilton, K. S. (2022) · PLoS ONE · doi:10.1371/journal.pone.0266826 · Cited by 18 · see citing works
“Numerous factors have been identified by clinicians as barriers to initiating ACP conversations in PLwD including unpredictable illness trajectory; uncertainty about the right time to commence the ACP process [10–12]; lack of time, resources, and knowledge; discomfort with ACP discussions [8, 13]; and difficulty in de…”
BackgroundLee, L., Hillier, L. M., Locklin, J., Lee, J., & Slonim, K. (2019) · Journal of Palliative Care · doi:10.1177/0825859718812463 · Cited by 16 · see citing works
- Authors
- Fulmer, T., Escobedo, M., Berman, A., Koren, M. J., Hernández, S., & Hult, A.
- Affiliations
- John A. Hartford Foundation (US)
- California HealthCare Foundation (US)
- Kuni Foundation Vancouver WA
- Corresponding author
- Fulmer, Terry
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2018-05-23
- Volume
- 66
- Issue
- 6
- Pages
- 1201-1205
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W2803502790
- Cited by
- 173
- References
- 16
- Citations by year
- 2026: 10 · 2025: 19 · 2024: 24 · 2023: 26 · 2022: 26 · 2021: 24 · 2020: 28 · 2019: 10 · 2018: 5
- FWCI
- 15.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Funders
- John A. Hartford Foundation
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- advance care planning, end-of-life care, end-of-life discussions, physician attitudes, barriers to advance care planning, physician training, goals of care, older adults, Medicare reimbursement, medical curriculum
- MeSH terms
- Aged, Attitude of Health Personnel, Female, Humans, Inservice Training, Interviews as Topic, Male, Physician-Patient Relations, Physicians, Terminal Care, United States, Health Care Surveys, Needs Assessment, Advance Care Planning
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
