Advance Care Planning in Chronically Ill Persons Diagnosed With Heart Failure or Chronic Obstructive Pulmonary Disease: An Integrative Review

Molly T. Williams, Sharon L. Kozachik, Mohana Karlekar, Rebecca Wright

Research output: Contribution to journalReview articlepeer-review


Introduction: Advance care planning (ACP) discussions help guide future medical care consistent with patient wishes. These discussions should be a part of routine care and should be readdressed frequently as a patient’s medical condition changes. Limited literature exists supporting structured processes for identifying persons who may benefit from these conversations. The purpose of this integrative review was to understand whether targeting patients with episodic disease trajectories in the acute care setting will increase their willingness to participate in ACP discussions. Methods: Using the Johns Hopkins Nursing Evidence-Based Practice Model as a guideline, this integrative review focused on the research query “In the acute care setting, does targeting patients with heart failure or chronic obstructive pulmonary disease for ACP lead to increased willingness to participate in these discussions.” Articles from 2009 to September 2019 were considered for review. Results: Six articles met inclusion criteria for final analysis. Articles outside of the United States were excluded. Four themes emerged from the literature: (1) improved patient attitudes toward ACP, (2) effective communication surrounding care preferences, (3) strengthened connection between preferred and delivered care, and (4) increased patient involvement in ACP. Conclusion: Chronic diseases such as heart failure and COPD have a high symptom burden punctuated by exacerbations, making it difficult to know when introduction of ACP discussions would be most beneficial. Future research should focus on a deeper evaluation of when to introduce ACP conversations in this population and which ACP interventions are effective to facilitate these discussions.

Original languageEnglish (US)
Pages (from-to)950-956
Number of pages7
JournalAmerican Journal of Hospice and Palliative Medicine
Issue number11
StatePublished - Nov 1 2020
Externally publishedYes


  • COPD
  • acute care setting
  • advance care planning
  • advance directive
  • episodic disease trajectory
  • heart failure

ASJC Scopus subject areas

  • General Medicine


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