Track 18: Advance Care Planning (ACP)

 

11th American Healthcare Summit on November 15-17, 2022 in San Francisco, USA.

Introduction

Advance care planning is a process that tries to inform and facilitate medical decision making in the event that patients are unable to communicate their desires. Conversations with patients and families, the use of written advance directives that memorialise a patient's intentions, and the participation of surrogate decision makers who can represent a patient's interests, values, and preferences are all approaches to accomplish this procedure. In this chapter, we define advance care planning and advance directives and provide a discussion of how these concepts and methods have evolved in practise. We next look at how to practise advance care planning in the context of palliative care and give a list of questions to help guide advance care planning.

 

4 Advance Care Planning in a Family Setting

The practise of preparing for medical status change occurrences at the end of life is known as advance care planning (ACP). 

ACP often entails a conversation and assessment of the person with a life-limiting illness's grasp of his or her medical history, current condition, values, preferences, and resources. 

ACP emphasises decisions about withholding life-prolonging medical procedures over therapies that are desirable. 

It is crucial to clarify that ACP is not simply the accomplishment of an advance directive, while this may be a component of ACP.

Methods

Systematic search of the literature in PubMed, EMBASE, PsychInfo, CINAHL, and the Cochrane Library. 

Based on the title and abstract, articles on normative features of ACP were included. 

Purposive sampling was utilized to choose articles for full text document analysis due to the large number of inclusions, many of which had similar content. 

When saturation was reached, the analysis was terminated.

 

Advance Care Planning assists persons of any age or health status in understanding and sharing their personal values, life objectives, and preferences for future medical care. 

It is a gift you give to your loved ones who would otherwise struggle to make decisions about your care amid a medical emergency.

What Exactly Is Advance Care Planning?

Advance Care Planning is a process that unfolds over the course of a lifetime as objectives and values evolve. 

The following are the steps in the Advance Care Planning process:

Consider your preferences for future care if you become critically ill. 

Your desires may be influenced by your experiences, cultural and religious beliefs, values, and ambitions. Choosing a health care agent - someone you trust to make medical decisions for you if you are unable to do so yourself.

Speaking with your health care agent and other loved ones about your desires. 

This step can be difficult at times, but it is critical and may help avoid future confrontations.

Creating an Advance Care Plan document, such as an Advance Directive. 

In some cases, a doctor may advise you to fill out a Physician Order for Life-Sustaining Treatment (POLST) form.

Making copies and distributing them with your health care agent, doctors, and loved ones. 

Make certain that Your Advance Directive is included in your medical file. Review your Advance Care Planning documentation on a regular basis to ensure that names, contact information, and healthcare preferences have not changed.

 

Why Should I Fill Out An Advance Directive Form?

Nobody knows what the future holds, but we can try to prepare for it. 

We have automobile insurance, for example, to protect us financially in the event of an accident. 

When it comes to medical difficulties, most of us are accustomed to making our own judgments about whether or not to pursue medical treatments. 

Unfortunately, a catastrophic illness or injury can abruptly render us unable to convey our wishes, leaving our doctors and loved ones in the dark. 

Advance Care Planning allows us to avoid putting an unneeded strain on our loved ones while also retaining some influence over the care we get. 

It provides clinicians and families with the assurance that medical decisions are sound.

Palliative Care's Role

 

Preparing for Long-Term Care

Advance care planning refers to the involvement of patients and their family members in making decisions about their present and future medical treatment. 

This process frequently includes a discussion of the patient's current and anticipated medical needs, as well as elicitation of the patient's preferences for the use of life-sustaining treatments such as cardiopulmonary resuscitation, prolonged mechanical ventilation, artificial nutrition and hydration, or comfort care. 14 

These preferences can be formalised through the use of an advance directive. 

In complex or contested settings, palliative care clinicians may initiate or assist with advance care planning.

 

Why is the emphasis on long-term goals in advance care planning?

Medical treatment is constantly evolving. New medical technologies and developments in treatment enable medical personnel to treat and potentially cure more ailments. However, these same medical improvements can sometimes result in treatment that goes above and beyond what the patient desires. This can be prevented if care is tailored to the patient's specific needs.

 

When physicians understand their patients' goals, they can offer the medical therapies that are most likely to help them accomplish those goals. When patients are unable to speak for themselves, their health care agent and anyone speaking on their behalf can confidently collaborate with the medical team to fine-tune treatment options to match the patient's goals.

 

As a result, Advance Care Planning focuses less on specifics.

 

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