Come see - @JAMAInternalMed made a patient page about #advancecareplanning ! https://ja.ma/2oNuTOJ  There is some good and some bad news here 1/

The good news? The fact that this patient page is made. It is a great feature of this journal, and a great help for patients that medical/scientific knowledge is translated and made available 2/

The bad news? Patients deserve the best available information. @JAMAInternalMed did not get it completely right unfortunately. Here are my two cents: 3/

First of all: it is advance care planning - NOT AdvanceD --> because it is about planning "in advance" This is a commonly made mistake, and important to get this right as inappropriate concepts confuses practice (and boy, there is a lot of confusion about ACP) 4/

Second, the patient page stresses that "The best way to make sure that you receive the type of medical care that is in agreement with your values is to complete an advanced directive". This is a rather oldfashioned approach of ACP 5/

A more modern approach is to focus on value identification and the communication of these values to relatives and healthcare professionals. Yes, this is mentioned in the patient page, but it deserves -in my view- more attention than completing advance care directives 6/

We (with @IKorfage and many others) have described this here in more detail, a report of an international consensus process what ACP is and how you should engage in ACP https://thelancet.com/journals/lanonc/article/PIIS1470-2045(17)30582-X/fulltext @TheLancetOncol 7/

And third, the patient page "recommends that everyone creates an advanced directive [..]. The best time to make an advanced directive is when you are in good health and fully able to express your wishes". This needs more nuance too, and more research, because 8/

we know people's preferences may change, not everyone is open to engage in ACP so early, and ACP may need adaptation to be of use for people in other socio-legal / cultural settings (such as Asia, medical decision-making is more family-centered) 9/

So, yes! A well-meant applaus for the patient page initiative, BUT also a warm plea for an up-to-date and nuanced narrative. Because in the end, we are all committed to making sure that people receive care and treatment that fits their values. 10/10