Advance Care Planning in Critical Illness Management

Advance care planning (ACP) is a structured process through which individuals discuss and document their preferences for future medical treatment, especially in the context of life-threatening illness. In critical care settings, ACP serves to align interventions—such as mechanical ventilation, vasopressor support or renal replacement therapy—with patient values and desired goals, thereby avoiding unwanted or non-beneficial treatments. Effective ACP integrates multidisciplinary teams, clear communication with patients and families, and formal documentation such as advance directives or treatment orders. It encompasses prognosis discussions, designation of surrogate decision makers and periodic review of preferences in response to changing clinical status. Globally, ACP has been shown to improve patient and family satisfaction, reduce intensive care unit length of stay and facilitate transitions to palliative or comfort-focused care. Despite these benefits, practical implementation faces barriers including time constraints, variable clinician training and cultural attitudes towards end-of-life conversations.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Advance Care Planning in Critical Illness Management publication trend

The graph below shows the total number of articles in advance care planning in critical illness management across all publications each year (not limited to Nature Index journals).

Technical terms

Advance care planning (ACP): A process for discussing and documenting a patient’s treatment preferences in anticipation of future incapacity.

Surrogate decision maker: An individual authorised to make healthcare decisions on behalf of a patient who lacks decision-making capacity.

Goal-concordant care: Medical treatment that is consistent with the informed preferences and values of the patient.

Life-sustaining treatment: Interventions that maintain life by replacing or supporting a vital organ function, such as mechanical ventilation or dialysis.

Shared decision-making: A collaborative process in which clinicians and patients (or surrogates) jointly consider options, risks and benefits to reach care decisions.

References

1. Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review. Critical Care (2014).
2. Patient and family involvement in adult critical and intensive care settings: a scoping review. Health Expectations (2015).
3. Reported burden on informal caregivers of ICU survivors: a literature review. Critical Care (2016).