The Significance of Advance Care Planning: How Technology is Helping to Bridge the Gap

Advance Care Planning (ACP) is an important part of healthcare but is a conversation that is often overlooked or put on the backburner. In this recent Healthcare IT Today podcast, Dr. Rishi Sarna, Chief Clinical Officer at Backline, and Dr. Andy Gulbis, owner of Dr. G Medical Solutions, discussed the challenges surrounding ACP and how technological solutions like Backline are transforming the way healthcare providers approach these critical conversations.

Check out the full podcast on Healthcare IT Today.

The Challenges of Advanced Care Planning in Healthcare

Dr. Gulbis, a family physician who practices in rural Texas, described ACP as a very different type of conversation than one typically had in healthcare visits. When patients come to see the doctor, they are usually interested in issues relating to prevention, wellness, and management of health conditions. Both patients and providers might find the idea of discussing end-of-life care difficult to navigate.

"These conversations can be awkward," said Dr. Gulbis, acknowledging the morbidity associated with ACP discussions. “Patients come in with a health complaint or concern, and it's hard to pivot to a conversation about end-of-life care.”

This struggle is intensified by time constraints. Physicians already have to address a wide array of issues with patients. To include a discussion of ACP in the context of a regular office visit often seems out of place and an added burden.

Backline’s Solution: Streamlining Advanced Care Planning (ACP) for Patients and Providers

One key solution discussed by Dr. Sarna and Dr. Gulbis was how Backline, a secure communication platform, addresses the challenges of ACP by streamlining the process.

Dr. Sarna emphasized that in medicine, all know ACP is important, but there tends to be very little time to prioritize it. "It’s not that clinicians don’t want to offer ACP to their patients; it’s that they don’t always have the time, especially during a visit focused on preventing or treating a current issue," he said.

Backline’s platform solves this by allowing patients to complete ACP on their own time, using secure messaging or text communications. This model can be particularly helpful in rural healthcare, where patients may face barriers to accessing in-person visits or long-distance travel to specialists. “Being able to coordinate ACP through a HIPAA-compliant platform that patients are already comfortable with eases the ability to bridge the gap in communication,” Dr. Sarna said.

Patients can plan their sessions at times that suit them, thus avoiding additional in-person meetings and calls that may be hard to coordinate. With a more flexible digital approach, follow-up on completed ACPs is easier. This process ensures that everyone involved is on the same page when it comes to end-of-life care.

The Role of ACP in Improving Patient Care

ACP is not about checking boxes on a document, emphasized Dr. Gulbis, it is about giving the patients autonomy over his or her healthcare decisions.

"ACP allows a patient to think about what kind of quality of life they want and what their preferences are if they become seriously ill. Do they want to live a long life on life support, or would they prefer to be self-sufficient, even if it means a shorter life?" he asked.

Dr. Sarna recently completed his own ACP, something he thought he wouldn’t do until he was much older. “The process makes you think about the kind of care you would want if you couldn’t speak for yourself,” he said. "It’s a challenging conversation, but it’s one everyone should have once they reach adulthood."

Both doctors agreed that ACP is an essential part of patient care. Dr. Sarna said that in his clinical practice, even among healthcare professionals, there was a lack of knowledge about the difference between an Advance Care Plan (ACP) and an Advance Directive (AD). While an AD is a significant part of an ACP, the ACP is the broader approach that covers patient preferences, healthcare power of attorney, and quality-of-life decisions.

Why Hospitals Need to Embrace ACP

Another critical point discussed was addressing how patients can have their wishes respected in medical settings, especially during crises when they may not be able to communicate. Dr. Gulbis shared a case where a nursing home sent a patient to the hospital without any ACP or DNR documentation, forcing the hospital staff to perform life-sustaining measures that the patient may not have wanted.

"If you don’t have an ACP in place, it becomes a challenge to make decisions that align with the patient’s wishes,” said Dr. Gulbis. “These plans can help avoid family conflict and ensure that decisions are made based on the patient's documented preferences.”

Dr. Sarna reinforced this point, saying that ACPs need to become a standard of care, much like physical exams and vaccinations. “We need to start educating the system and patients that ACPs are important. It should be a part of routine care,” he said.

A Cultural Shift Toward End-of-Life Care

Both Dr. Sarna and Dr. Gulbis emphasized how ACP can offer a shift to the way the health system approaches end-of-life care. Typically, the only focus in medicine is fighting illness and prolonging life at all costs. By embracing ACP, healthcare providers can shift their mindset from simply extending life to improving the quality of life—especially when it comes to end-of-life decisions.

"This is not about giving up on care; it’s about providing the right care at the appropriate time," Dr. Gulbis said. "By having these conversations early on, we can help guide patients toward a more peaceful and dignified end-of-life process."

Dr. Sarna added, “It’s a success when we help patients make these decisions because it allows them to have more control over their care, and that leads to better outcomes for everyone.”

Moving Toward Better Care

As both physicians explained, ACP is not only for older patients or patients in terminal conditions. Everyone, at some point in their adulthood, should have an ACP in place to ensure their healthcare wishes are known and respected. By integrating technology into the process, healthcare providers can make these crucial conversations easier.