Instability in End-of-Life Goals and Preferences of Patients Who Are Seriously Ill

In the studies included in this systematic review, EOL care goals and preferences among patients who are seriously ill were unstable and influenced by transient clinical and emotional factors. These shifts often go undetected when preferences were assessed infrequently. These findings suggest that ACP should be reframed-not as a future-focused plan for goal-concordant EOL care, but as an ongoing approach that prepares patients who are seriously ill and their families for real-time decisions in the face of uncertainty.