RE: Adapting Primary Care Workflows to Promote Advance Care Planning

In “Adapting Primary Care Workflows to Promote Advance Care Planning," Valadares et al used Annual Medicare Wellness Visits (AWV) with patients over the age of 65 as an opportunity to address Advance Care Planning (ACP).(1) While ACP discussions are important, Family Physicians should not wait until patients turn 65 to have these discussions at a Medicare visit. Family Physicians should discuss end of life planning with adult patients of all ages.

The authors acknowledge how COVID-19 has drawn attention to planning for potential medical emergencies. The pandemic has reinforced that end of life discussions, unexpected declines, and terminal diagnoses can occur at any point in a patient’s life span. Only 1/3rd of the US adult population has completed ACP or HCPOA documents.(2) A significant proportion of persons in the United States who will receive a terminal diagnosis are under the age of 65.(3) These patients could significantly benefit from having discussions about their end of life wishes prior to their diagnoses. By waiting until a patient is over 65, a large audience that could benefit greatly from this discussion is lost.(4)

Primary Care Physicians are uniquely positioned to broach these difficult topics, and not just with patients over 65 or those with terminal diagnoses. These conversations can and should happen throughout the adult years to help prepare all of our patients and their families for the unexpected. Family Physicians should discuss ACP with all patients, not just those over the age of 65 presenting for the Annual Medicare Wellness Visit.

1. Valaderes, KJ et al. “Adapting Primary Care Workflows to Promote Advance Care Planning”. Ann Fam Med. 2022 Jul-Aug;20(4), 384.

2. Dinescu, A. “Advance Care Planning.” Clin Geriatr Med. 2021 Nov;37(4), 605–610.

3. “Age and Cancer Risk.” National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/age. Accessed 8-10-22.

4. Tripken JL, Elrod CS. “Young Adults’ Perspective On Advance Care Planning.” Am J Hosp Palliat Care. 2018 Apr;35(4), 627-634.