Although more Americans are reporting that they have documented their wishes and values for end-of-life care, there are signals that this upward trend could reverse. As fears and restrictions related to the COVID-19 pandemic ease, and as the death toll declines, Americans are also reporting they are now less likely to discuss or document their plan for end-of-life care, compared to a year ago. The findings come from a new nationwide study commissioned by VITAS Healthcare.

The poll reveals new insights on trends among different generations and ethnic/racial groups, as well as the current – and potential – role healthcare professionals play in discussing and documenting one’s wishes and values for end-of-life care.

“The pandemic has, unfortunately, brought death to the doorsteps of many Americans. Compared to 2021, we see that more people report having documented their end-of-life wishes, which is a positive sign,” said Dr. Joseph Shega, VITAS executive vice president and chief medical officer. “However, we are also seeing a decline in indication that those who have not yet documented their plans will do so, possibly tied to a COVID-19 reprieve on the horizon. Seeing this, I can’t overstate the importance of advance care planning (ACP) and advance directives. ACP allows patients to make their preferences known early, and knowing a patient’s wishes for end-of-life care ensures care aligns with their goals and values while also relieving the burden on families to make critical medical decisions on behalf of their loved ones.”

Among the survey’s key highlights is the increased openness to advance care planning reported by Black Americans, the undeniable role of healthcare professionals in initiating end-of-life conversations, and the need for more open and frank discussions about patients’ wishes concerning their care.

The survey’s findings include:

  • An increase in the number of people documenting their wishes, which corresponds to last year’s uptick in openness to advance care planning. But waning interest in advance care planning may mean that upward trend will vanish.
  • However, the trend may not be vanishing across the board. Interest in advance care planning has risen among Black Americans, who have been disproportionately affected by COVID-19.
  • Healthcare professionals (HCPs) continue to be imperative in starting advance care planning conversations. Americans report, however, that HCPs are not raising the issue.

Research published by the American Geriatrics Society in 2018 showed that 99% of physicians believe it is important to have end-of-life care conversations, yet only 29% report having formal training to equip them. To educate and empower healthcare professionals, such as nurses, nurse practitioners and physicians to have conversations with patients about their end-of-life care, VITAS is launching a preceptorship and certificate program. To be introduced at the upcoming National Black Nurses Association Annual Conference in July, the program includes education modules on a variety of topics, such as prognostication, hospice basics, and how to start the advance care planning conversation sensitively and respectfully with open-ended questions. It also includes practice scenarios where participants can get feedback on actual conversations with patients.

Patients and families can download Thinking About Hospice, a discussion guide for families, available in English, Spanish, Mandarin, Vietnamese and Tagalog at