Numerous studies have shown that advance care planning increases the likelihood that caregivers can follow end of life wishes. Families of patients who had discussed their goals show decreased levels of stress and anxiety surrounding the death of their loved ones. Yet many Americans do not engage in advance care planning or have advance directives. In some surveys, less than 30 percent of respondents have advance directives. Most people without advance directives cited lack of awareness as the main reason for not having one. Lower socioeconomic status and non-white race were linked to lower rates of completion of advance directives. As people age, the likelihood of having an advance directive more than doubles. Unfortunately, even when advance care planning does take place, there is often inadequate documentation of the discussions. The paucity of advance care planning is evident in recent data from the Centers for Medicare and Medicaid Services (CMS). In 2016, CMS allowed providers to bill for advance care planning. But only 575,000 patients of the nearly 57 million eligible patients had a billed conversation in the first year of the law, according to CMS.

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