Advance Care Planning - Your Health, Your Wishes

Advance Care Planning (ACP)

An organized process of coming to understand, reflect upon and discuss goals for future healthcare decisions in the context of their individual beliefs and values.

It involves identifying personal healthcare goals and exploring treatment options that will help you determine preferences so that you can receive the types of healthcare that you prefer in various situations.

Goals of Advance Care Planning

• Improve your understanding of health conditions and treatment options
• Clarify your health care goals and values
• Identify a patient advocate
• Communicate your wishes with your loved ones and healthcare providers
• Document your healthcare wishes through the completion of an advance directive

What will it do for me?

• Minimize the likelihood of over-treatment or under-treatment
• Reduce the likelihood of conflicts between loved ones and the health care providers
• Minimize the burden of decision making on loved ones

Start by imagining a situation in which you are unexpectedly incapable of making healthcare decisions for yourself. In this situation you will have little or no chance at recovery, or your injury or loss of function is significant. This situation was caused by a sudden accident, a stroke, or a disease such as Alzheimer’s.

Reflect

• What experiences or stories do you have that relate to how you would feel in this situation?
• What beliefs, values or preferences do you have that would shape your healthcare choices in this situation?
• Who would you want to include in your reflection and future discussions (i.e., physician, spiritual leader, mental health providers, friends, family, loved ones)?
• What makes my life worthwhile (what types of things bring quality to my life)?

Evaluate

• What preferences do you have regarding medical interventions in severe brain injury situations?
• How serious would the illness or injury be for your goals of care to be aggressive vs comforting in nature?
• When would the use of a ventilator be helpful?
• When would tube feeding be helpful?
• In which situations would I want to have CPR performed?
• Does my religion have a position on end-of-life care?

Learn

• More about different types of care options life-supporting, life-sustaining and life-enhancing treatments

It is important for medical professionals and your loved ones to know what your values and wishes are. You should discuss your thoughts, concerns and choices with them. It helps to begin conversations by sharing what things are important for you to live well. Certified facilitators can assist you with these conversations if you find them difficult.

Choosing your patient advocate is one of the most important decisions that you will make in the advance care planning process. The individual that you choose will be someone who makes medical decisions for you in the event that you are unable to make them for yourself. Your patient advocate should be someone that knows you well, but it does not have to be a relative. It is recommended to choose at least one successor advocate in the event that your primary advocate is unable or unwilling to act on your behalf.

Your patient advocate MUST be 18. Your patient advocate should also be:

• Reachable in the event of an emergency
• Willing to follow the values and instructions that you have discussed with them even if they don’t agree with them
• Willing to stand up for you to your loved ones and healthcare providers and insist that your wishes are honored
• Able to make complex, difficult decisions during stressful situations
• Willing to accept this responsibility

Use the workbook, A Guide to Completing Your Designation of Patient Advocate Form to begin to organize and solidify your wishes for future healthcare choices. When you feel as though your thoughts and decisions are complete, transfer the information from your workbook to the legal document, Designation of Patient Advocate Form.

Some examples of specific, personalized wishes that have been identified:

• I do not want to be in pain.
• I want to have enough medication to relieve my pain, even if it means I will sleep more than usual.
• I want to die in my home.
• I want to be referred to hospice earlier rather than later.
• I want to donate tissue or organs to the Gift of Life.
• I want to have my favorite music played, even if I seem unresponsive.
• I wish to have daily prayers said at my bedside.
• I want friends and relatives to visit, hold my hand, and talk to me about the daily lives of their families.
• I have spoken with my Health Care Agent about the things I want and don’t want, and I want you to respect them by honoring my wishes.

In order to for the form to be complete and usable, your signature MUST be witnessed by two individuals (see page 9 of the Patient Advocate Form for details).

Once you have completed a Designation of Patient Advocate Form, your patient advocate(s) should keep a completed copy and present it when they need to discuss your care and treatment with your medical providers. You should also carry the wallet card with the name of your Patient Advocate found in your Designation of Patient Advocate form. It is important to provide completed copies of the form to:

• Your primary care provider (such as your family doctor or equivalent)
• Any family members who may need to know how to contact your advocate in the event of an emergency
• The individuals that you have chosen to be your successor advocate(s)
• Your closest hospital (wherever you would go for emergencies) in the Advance Care Planning or Health Information office.
• Other medical facilities (such as hospitals or nursing homes) where you frequently receive treatment, or upon being admitted for a major procedure, such as surgery

Advance Care Planning is not a single conversation. It is a process that takes place over time. At the very least, the content of your completed Patient Advocate Form should be reviewed at the occurrence of any of the “5 D’s”:

1. The Death of a loved one
2. Upon Divorce
3. At the time of a new Diagnosis
4. When a major health Decline occurs
5. Every Decade