The following is a summary of “Value of Advance Care Planning for Spokespersons of Patients With Advanced Illness,” published in the January 2023 issue of Pain Management by Kunzler, et al.

Advance Care Planning (ACP) has faced criticism due to inconsistent evidence regarding its benefits for patients. Therefore, research was needed to understand how spokespersons perceive, engage with, and find value in ACP decision-making for their loved ones. For qualitative analysis, researchers aimed to explore how spokespersons view and interact with ACP and assess its value in the decision-making process for their loved ones.

The analysis was conducted as part of a randomized controlled trial involving spokespersons of patients with advanced illnesses who had completed ACP. Semi-structured interviews were conducted with spokespersons after they made medical decisions on behalf of their loved ones or following their loved one’s death. The interviews explored the spokespersons’ experiences with decision-making and the role of ACP, if any. In addition, thematic analysis was performed on the interview transcripts.

A total of 120 interviews were conducted, leading to the identification of five key themes. First, written advance directives (ADs) increased spokespersons’ confidence in aligning decisions with the patient’s wishes, as a tangible reminder of previous discussions and helping during decision-making and family conflicts. Second, iterative discussions involving ACP supported “in the moment” decision-making. Third, ADs and ACP conversations helped spokespersons better prepare for future decisions. Fourth, some spokespersons felt they had no choice regarding their loved one’s medical care. Finally, regrets and second-guessing were common negative emotions experienced by spokespersons.

In the context of ongoing debates about the usefulness of ACP and ADs, the qualitative analysis highlights the value of ACP for spokespersons involved in surrogate decision-making. By reframing the goals of ACP to focus on the benefits for spokespersons and identifying appropriate outcome measures, additional insights into the utility of ACP can be gained.