EPECEPECEPECEPEC EPECEPECEPECEPEC Advance Care Planning Advance Care Planning Module 1 The Project...
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Transcript of EPECEPECEPECEPEC EPECEPECEPECEPEC Advance Care Planning Advance Care Planning Module 1 The Project...
EEPPEECC
EEPPEECC
Advance CarePlanning
Advance CarePlanning
Module 1Module 1Module 1Module 1
The Project to Educate Physicians on End-of-life CareSupported by the American Medical Association andthe Robert Wood Johnson Foundation
The Project to Educate Physicians on End-of-life CareSupported by the American Medical Association andthe Robert Wood Johnson Foundation
Objectives . . .Objectives . . .
Define advance care planning, Define advance care planning, explain its importanceexplain its importance
Describe the steps of advance care Describe the steps of advance care planningplanning
Describe the role of patient, proxy, Describe the role of patient, proxy, physician, othersphysician, others
Define advance care planning, Define advance care planning, explain its importanceexplain its importance
Describe the steps of advance care Describe the steps of advance care planningplanning
Describe the role of patient, proxy, Describe the role of patient, proxy, physician, othersphysician, others
. . . Objectives. . . Objectives
Distinguish between statutory and Distinguish between statutory and advisory documentsadvisory documents
Identify pitfalls and limitations in Identify pitfalls and limitations in advance care planningadvance care planning
Utilize planning to help put affairs in Utilize planning to help put affairs in orderorder
Distinguish between statutory and Distinguish between statutory and advisory documentsadvisory documents
Identify pitfalls and limitations in Identify pitfalls and limitations in advance care planningadvance care planning
Utilize planning to help put affairs in Utilize planning to help put affairs in orderorder
What is advance care planning? . . .What is advance care planning? . . . Process of planning for future Process of planning for future
medical caremedical care
Values and goals are explored, Values and goals are explored, documenteddocumented
Determine proxy decision makerDetermine proxy decision maker
Professional, legal responsibilityProfessional, legal responsibility
Process of planning for future Process of planning for future medical caremedical care
Values and goals are explored, Values and goals are explored, documenteddocumented
Determine proxy decision makerDetermine proxy decision maker
Professional, legal responsibilityProfessional, legal responsibility
. . . What is advance care planning?. . . What is advance care planning? Trust buildingTrust building
Uncertainty reducedUncertainty reduced
Helps to avoid confusion and conflictHelps to avoid confusion and conflict
Permits peace of mindPermits peace of mind
Trust buildingTrust building
Uncertainty reducedUncertainty reduced
Helps to avoid confusion and conflictHelps to avoid confusion and conflict
Permits peace of mindPermits peace of mind
5 steps for successful advance care planning5 steps for successful advance care planning
1.1. Introduce the topic Introduce the topic
2.2. Engage in structured discussions Engage in structured discussions
3.3. Document patient preferences Document patient preferences
4.4. Review, update Review, update
5. 5. Apply directives when need arisesApply directives when need arises
1.1. Introduce the topic Introduce the topic
2.2. Engage in structured discussions Engage in structured discussions
3.3. Document patient preferences Document patient preferences
4.4. Review, update Review, update
5. 5. Apply directives when need arisesApply directives when need arises
Step 1: Introducethe topicStep 1: Introducethe topic Be straightforward and routineBe straightforward and routine
Determine patient familiarityDetermine patient familiarity
Explain the processExplain the process
Determine comfort levelDetermine comfort level
Determine proxyDetermine proxy
Be straightforward and routineBe straightforward and routine
Determine patient familiarityDetermine patient familiarity
Explain the processExplain the process
Determine comfort levelDetermine comfort level
Determine proxyDetermine proxy
Step 2: Engage is structured discussionsStep 2: Engage is structured discussions Proxy decision maker(s) presentProxy decision maker(s) present
Describe scenarios, options for careDescribe scenarios, options for care
Elicit patient’s values, goalsElicit patient’s values, goals
Use a worksheetUse a worksheet
Check for inconsistenciesCheck for inconsistencies
Proxy decision maker(s) presentProxy decision maker(s) present
Describe scenarios, options for careDescribe scenarios, options for care
Elicit patient’s values, goalsElicit patient’s values, goals
Use a worksheetUse a worksheet
Check for inconsistenciesCheck for inconsistencies
Role of the proxyRole of the proxy
Entrusted to speak for the patientEntrusted to speak for the patient
Involved in the discussionsInvolved in the discussions
Must be willing, able to take the Must be willing, able to take the proxy roleproxy role
Entrusted to speak for the patientEntrusted to speak for the patient
Involved in the discussionsInvolved in the discussions
Must be willing, able to take the Must be willing, able to take the proxy roleproxy role
Patient and proxy educationPatient and proxy education Define key medical termsDefine key medical terms
Explain benefits, burdens of Explain benefits, burdens of treatmentstreatments
Life support may only be short-termLife support may only be short-term
Any intervention can be refusedAny intervention can be refused
Recovery cannot always be predictedRecovery cannot always be predicted
Define key medical termsDefine key medical terms
Explain benefits, burdens of Explain benefits, burdens of treatmentstreatments
Life support may only be short-termLife support may only be short-term
Any intervention can be refusedAny intervention can be refused
Recovery cannot always be predictedRecovery cannot always be predicted
Elicit the patient’s values and goalsElicit the patient’s values and goals Ask about past experiencesAsk about past experiences
Describe possible situationsDescribe possible situations
Write a letterWrite a letter
Ask about past experiencesAsk about past experiences
Describe possible situationsDescribe possible situations
Write a letterWrite a letter
Use a validated advisory documentUse a validated advisory document A number are availableA number are available
Easy to useEasy to use
Reduces chance for omissionsReduces chance for omissions
Patients, proxy, family can take homePatients, proxy, family can take home
A number are availableA number are available
Easy to useEasy to use
Reduces chance for omissionsReduces chance for omissions
Patients, proxy, family can take homePatients, proxy, family can take home
Step 3: Document patient preferencesStep 3: Document patient preferences Review advance directiveReview advance directive
Sign the documentationSign the documentation
Enter into the medical recordEnter into the medical record
Recommend statutory documentsRecommend statutory documents
Ensure portabilityEnsure portability
Review advance directiveReview advance directive
Sign the documentationSign the documentation
Enter into the medical recordEnter into the medical record
Recommend statutory documentsRecommend statutory documents
Ensure portabilityEnsure portability
Step 4: Review, updateStep 4: Review, update
Follow up periodicallyFollow up periodically
Note major life eventsNote major life events
Discuss, document changesDiscuss, document changes
Follow up periodicallyFollow up periodically
Note major life eventsNote major life events
Discuss, document changesDiscuss, document changes
Step 5: Apply directivesStep 5: Apply directives
Determine applicabilityDetermine applicability
Read and interpret the advance Read and interpret the advance directivedirective
Consult with the proxyConsult with the proxy
Ethics committee for disagreementsEthics committee for disagreements
Carry out the treatment planCarry out the treatment plan
Determine applicabilityDetermine applicability
Read and interpret the advance Read and interpret the advance directivedirective
Consult with the proxyConsult with the proxy
Ethics committee for disagreementsEthics committee for disagreements
Carry out the treatment planCarry out the treatment plan
Common pitfallsCommon pitfalls
Failure to planFailure to plan
Proxy absent for discussionsProxy absent for discussions
Unclear patient preferencesUnclear patient preferences
Focus too narrowFocus too narrow
Communicative patients are ignoredCommunicative patients are ignored
Making assumptionsMaking assumptions
Failure to planFailure to plan
Proxy absent for discussionsProxy absent for discussions
Unclear patient preferencesUnclear patient preferences
Focus too narrowFocus too narrow
Communicative patients are ignoredCommunicative patients are ignored
Making assumptionsMaking assumptions
Preparation for the last hours of life . . . Preparation for the last hours of life . . . Advance planningAdvance planning
personal choicespersonal choices
caregiverscaregivers
settingsetting
Loss, grief, coping strategiesLoss, grief, coping strategies
Advance planningAdvance planning
personal choicespersonal choices
caregiverscaregivers
settingsetting
Loss, grief, coping strategiesLoss, grief, coping strategies
. . . Preparation for last hours of life. . . Preparation for last hours of life Educating / training patients, families Educating / training patients, families
and caregiversand caregivers
communicationcommunication
tasks of caringtasks of caring
what to expectwhat to expect
physiologic changes, eventsphysiologic changes, events
symptom managementsymptom management
Educating / training patients, families Educating / training patients, families and caregiversand caregivers
communicationcommunication
tasks of caringtasks of caring
what to expectwhat to expect
physiologic changes, eventsphysiologic changes, events
symptom managementsymptom management
Advance practical planning . . .Advance practical planning . . . Financial, legal affairsFinancial, legal affairs
Final giftsFinal gifts
bequestsbequests
organ donationorgan donation
AutopsyAutopsy
Financial, legal affairsFinancial, legal affairs
Final giftsFinal gifts
bequestsbequests
organ donationorgan donation
AutopsyAutopsy
. . . Advance practical planning. . . Advance practical planning Burial / cremationBurial / cremation
Funeral / memorial servicesFuneral / memorial services
GuardianshipGuardianship
Burial / cremationBurial / cremation
Funeral / memorial servicesFuneral / memorial services
GuardianshipGuardianship
Choice of caregiversChoice of caregivers
Be family first, caregivers only if Be family first, caregivers only if comfortablecomfortable
everyone comfortable in the roleeveryone comfortable in the role
seek permissionseek permission
change roles if stressedchange roles if stressed
Be family first, caregivers only if Be family first, caregivers only if comfortablecomfortable
everyone comfortable in the roleeveryone comfortable in the role
seek permissionseek permission
change roles if stressedchange roles if stressed
Choice of setting . . .Choice of setting . . .
Burdens, benefits weighedBurdens, benefits weighed
Permit family presencePermit family presence
privacyprivacy
intimacyintimacy
Burdens, benefits weighedBurdens, benefits weighed
Permit family presencePermit family presence
privacyprivacy
intimacyintimacy
. . .Choice of setting . . .Choice of setting
Minimize family burdenMinimize family burden
risk to career, personal economics, risk to career, personal economics, healthhealth
ghostsghosts
Alternate setting as backupAlternate setting as backup
Minimize family burdenMinimize family burden
risk to career, personal economics, risk to career, personal economics, healthhealth
ghostsghosts
Alternate setting as backupAlternate setting as backup