Advance Care Planning

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Introduction

Welcome to our resource site for patients, families and health care providers looking for more information about Advance Care Planning (ACP). Although it may be taboo or difficult for many people to talk about ACP, it's very important that people legally assign a decision maker and document their wishes on paper so that we as health care professionals can abide by them. ACP will also help your decision maker with difficult decisions when you are unable to make them for yourself. Just as planning a trip takes time, energy and thought, ACP should receive the same energy. ACP usually involves filling out an Advance Health Care Directive. This site has multiple helpful resources. Please click on the appropriate link to the left to access these resources. 

Definition of Advance Health Care Directive

Advance Health Care Directive (A.K.A. Living Will, Advance Directive, Advance Care Directive, Personal Directive) are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity, and appoints a person to make such decisions on their behalf. This person is called the Durable Power of Attorney (DPOA) for healthcare.

Advance Care Planning Through Time

1. Everyone over the age of 18 should have an Advance Health Care Directive (AHCD). 

A. Make sure you review your AHCD with your physician, as many AHCD are completed as part of estate planning with a lawyer and their clinical guidance may be lacking or insufficient. Often times I see AHCD that are signed but incomplete making it much more difficult for families to interpret if the person is incapacitated to make their own decisions.

B. Be as specific as possible in your AHCD. This step can be difficult as you are not sure what to anticipate. I highly recommend time trials of interventions especially if heroic and aggressive measures are to be used in your AHCD. For example, I've had patients request to have all aggressive measures to be done, but stated in their AHCD, that if there was lack of improvement for a "meaningful recovery," as discussed with their decision maker prior to hospitalization, then they would want the focus of care changed to compassionate extubation (if they are intubated) or comfort measures.

C. Please choose your decision maker or DPOA carefully. It should be someone who knows you well including your goals, values and wishes. More than what's stated on your AHCD is the CONVERSATION behind your wishes. The more you talk with your DPOA about what is important in your life, what you consider quality of life and what is and isn't an acceptable medical intervention, the better they will be able to make decisions on your behalf.

2. AHCD should be reviewed every year and updated if you have changed your mind about any aspect of your AHCD, whenever there is a change in your medical condition or if you have changed your mind about who your DPOA for healthcare will be.

3.  A Physicians Order for Life Sustaining Treatment (POLST) form should be completed if you have been diagnosed with a chronic or serious progressive illness at any age. *NOTE: A POLST Form doesn't take the place of an AHCD. We recommend you keep your AHCD and POLST form together as they both provide vital information that will be important to your healthcare team.

A. After the diagnosis of a chronic or serious progressive illness, you may want to consider having a Palliative Care Team involved in your care. Unfortunately, palliative care involvement for patients is limited at this time due to varying availability in different settings and locations.

4. Your POLST form should be reviewed every year and updated if you have changed your mind about any aspect of your POLST form or if there is a change in your medical condition.

A. If your chronic or serious progressive illness has worsened and a physician feels your overall prognosis is poor, a life expectancy estimated at 6 months or less, you may consider Hospice Care. The majority of Americans prefer to die at home, however this only occurs in about a quarter of the time.   

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