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Advance care planning — CCFP MCQ

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ModerateGeriatricsAdvance care planningCCFP

An 84-year-old man with severe COPD, CKD and frailty asks about advance care planning. He says he values being at home and avoiding burdensome treatment. His daughter says the family does not talk about death. What is the most appropriate next step in management?

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Correct answer: C — Explore his values, identify a substitute decision-maker and document goals of care while inviting family discussion with permission

The correct answer is C. Best practice in advance care planning (ACP) is to proactively explore the patient's own goals, values, and preferences while the patient has capacity and before a health crisis. Canadian guidance emphasizes that ACP includes clarifying what is most important to the patient, appointing a substitute decision-maker, and documenting decisions; family should be included only with the patient's consent. Option B is wrong because waiting risks loss of capacity and missing the patient's preferences. Option D fails to respect the patient's autonomy, which is central to ACP. Option A treats DNR as a form to complete rather than a process founded on values and wishes, leading to inappropriate or unhelpful directives. Option E shows a misunderstanding—addressing ACP carefully does not reduce hope, and failing to do so risks unwanted interventions. Thus, option C follows all key Canadian family medicine recommendations for ACP.

Reference: Advance care planning | Canadian Family Physician. 2015. https://www.cfp.ca/content/61/8/663