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Advance Care Planning

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by

simran malhotra

on 6 August 2013

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Transcript of Advance Care Planning

DOCUMENTATION, REVIEW & UPDATE
ROOTS
WHAT IS IT?
Advance Care Planning...
...thinking about the future
ONE BRANCH at a time

- Plan for future medical care

- Communication >>> legal process

- Health care proxy
WHY IS ACP IMPORTANT?
ERA OF CHRONIC MEDICAL CONDITIONS AND GERIATRICS
RISK OF COGNITIVE DECLINE
PREVENTS CONFUSION
AND CONFLICT
OUTPATIENT SETTING
PATIENT
AUTONOMY
ENHANCES PHYSICIAN-PATIENT
RELATIONSHIP AND TRUST
HEALTH CARE
PROXY
LIVING
WILL
ADVANCE
DIRECTIVES

<--- 2 TYPES
CHF
COPD
HIV
ESRD
MALIGNANCY
CVA
DEMENTIA
CIRRHOSIS
EPEC
Education in Palliative and End-of-life Care
INTRODUCTION
INTEGRATE INTO
ROUTINE VISIT
INITIATE DURING
STABLE CONDITION
DETERMINE PATIENT'S
KNOWLEDGE
DETERMINE
COMFORT LEVEL
DO NOT
FORCE TOPIC!
HEALTH CARE PROXY
WHO WOULD YOU
WANT TO SPEAK
FOR YOU IF YOU
COULDN'T SPEAK
FOR YOURSELF
SOMEONE TO REPRESENT PTS
VALUES AND GOALS.
..

SOMEONE THAT IS
TRUSTED
BY PT...

DOESN'T
HAVE TO BE A FAMILY MEMBER...
ASSESS PREFERENCES
&
CONDUCT DISCUSSIONS
ASSESS UNDERSTANDING OF CHRONIC ILLNESSES
(I.E. BENEFIT VS. RISK OF TREATMENT/ PROGNOSIS)
GIVE DEFINITIONS OF MEDICAL TERMS (I.E. DNR, FULL CODE, ETC)

DESCRIBE SCENARIOS
PAST EXPERIENCES WITH HOSPITALIZATIONS, FRIENDS OR FAMILY?
PATIENT VALUES?
GOALS FOR CARE?
REVIEW
PUT IN MEDICAL RECORD
MAKE COPIES
REVISIT
APPLY DIRECTIVES
REVIEW IN ACUTE SETTING

INFORM ENTIRE MEDICAL TEAM

ETHICS COMMITTEE FOR DISAGREEMENTS
COMMON PITFALLS
MC: INITIATED FOR THE 1ST TIME IN ACUTE SETTING
(I.E. HOSPITALIZATION)

FAILURE TO PLAN AHEAD

LITTLE INVOLVEMENT OF PROXY

ADVANCE DIRECTIVES NOT READ

TIME
DISCOMFORT
&
INEXPERIENCE
PATIENT DISCOMFORT
FAMILY DISAGREEMENTS
PHYSICIAN
BARRIERS

SAVES TIME IN THE FUTURE

MOST PLANNING DONE BY PATIENT & FAMILY

PLANNING CAN BE REIMBURSED
"BEST CARE POSSIBLE"
PRACTICE MAKES PERFECT
LEARN FROM YOUR COLLEAGUES
- TALKING ABOUT DEATH
- LANGUAGE BARRIER
PATIENT PERSPECTIVES
- PHYSICIAN SHOULD MAKE DECISION

- FAMILY SHOULD MAKE DECISION

- DEATH TALK --> HASTENS PROCESS

- EMOTIONAL/PHYSICAL BURDEN

- BELIEVE ITS IRREVERSIBLE

- NEED A LAWYER

- DO NOT TRUST MEDICAL SYSTEM
MOSTLY SEEN IN ACUTE SETTING
CONDUCT FAMILY MEETINGS
INVOLVE SOCIAL WORKERS
OR OTHER MEDIATORS
TAKE HOME POINTS
COMMUNICATION COMMUNICATION COMMUNICATION!
PATIENT AUTONOMY!
AVOID WAITING UNTIL CRISIS!
Full transcript