Frequently Asked Questions About Advance Care Planning
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Every adult should make an advance care plan, while in control of physical and mental capacities. No one can predict how or when they may become critically ill or otherwise incapacitated.
What is advance care planning?
Advance care planning is a process of reflection on your values and wishes, and letting others know your health and personal care preferences for end-of-life treatment, in the event that you become incapable of consenting to – or refusing – treatment or other care.
- It means discussing your wishes with the person(s) who will speak for you at a time when you cannot speak for yourself – and with your health-care providers, either in a hospital, a long-term care home or a community care setting.
- It means having those discussions or writing down your preferences for end-of-life care, while you are physically and mentally well, and not influenced by an emergency situation.
- It means naming your Substitute Decision Maker (SDM) – the person who will speak for you when you cannot speak for yourself.
- Advance care planning is about quality of living and being in control of how you live and die.
Why is advance care planning so important?
- Approximately 50 per cent of the families we serve do not know their loved ones’ wishes, but who may at some point have to make difficult decisions regarding their loved one’s care.
- When faced with sudden, end-of-life decisions, most people will ask for interventions for their loved ones that they would not want for themselves because most people do not want to feel responsible for making decisions at the end of another person’s life.
- Research indicates that patients who have end-of-life conversations with their doctors and family members are much more likely to be satisfied with their care and will require fewer aggressive or heroic interventions at the end of life, placing less strain on loved ones and health providers.
Your plans can be changed by you at any time
Who should make an advance care plan – and when?
Every adult should make a plan, while in control of physical and mental capacities. No one can predict how or when they may become critically ill or otherwise incapacitated; having a documented plan ensures that others know your wishes for end-of-life care, and that your voice will be heard if you cannot speak for yourself.
What are the benefits of advance care planning?
There are benefits to both you and your loved ones. Discussing your thoughts, concerns and choices with your family, SDM and those close to you ensures that they:
- understand them and
- are willing to honor them.
Discussing with your Substitute Decision-Maker, family and friends now about what level of care you do and do not want in the future will decrease their anxiety and help them to feel confident about your decisions when they need to make decisions on your behalf.
Having a documented plan ensures that others know your wishes for end-of-life care, and that your voice will be heard if you cannot speak for yourself.
Why has Eastern Health implemented a policy around Advance Care Planning?
Advance Care planning is not a new concept. Eastern Health and its legacy organizations have had previous discussions, consults and forums on practical and ethical issues regarding care at the end of life. Advance care planning has been practiced in long-term care settings for many years. However, the ACP Policy is Eastern Health’s first comprehensive and collaborative regional strategy, whose objective is:
- to raise awareness of advanced care planning with more robust conversations – earlier in a person’s health journey – and in all health-care settings (community, acute and long-term care);
- to require and equip health professionals to engage patients and families in conversations, in an appropriate manner and at an appropriate time; and
- to document end-of-life decisions.
The ACP policy will also:
- standardize the health-care intervention designations such as ‘Resuscitation,’ Medical care’ and ‘Comfort care’ (RMC) throughout the organization;
- incorporate CPR and Do Not Resuscitate (DNR) decision-making into the above RMC designations; and
- support the transfer of ACP at the transition of care points, such as from community care to acute care, or from acute care to long-term care.
Once you have completed your plan, give copies of your plan to your doctor and those who are close to you, including your substitute decision maker, and also keep a copy for yourself in an accessible place.
How will Eastern Health’s Advance Care Policy affect those admitted to hospital or who are patients of the Dr. H. Bliss Murphy Cancer Centre?
As of May 17, 2016, conversations about advance care planning will be much more consistent and comprehensive within the acute care system. Even if the medical issue for which you were admitted is considered routine or non-life-threatening, it will be common practice for the subject of advance care planning to be introduced by a health- care provider such as a:
- physician,
- nurse, or
- social worker
If you are able to indicate your own preferences regarding end-of-life care, they will be placed in your medical chart by your attending physician and become part of your medical record for that hospital visit. You will be asked again what your end-of-life wishes are at each subsequent hospital visit, as medical situations may change and evolve and your wishes for care and treatment plans may need to change to match your ongoing needs, goals and values.
Your plan is only used if you are unable to make your own health-care decisions (i.e. you are in a coma or your illness has impaired your ability to make decisions). Your substitute decision-maker can use it to guide your care and express wishes on your behalf.
If you have already completed an advance care plan in another format, we ask that you or your Substitute Decision Maker share that information with our staff.
How else can I document my plans?
There are a number of ways you can make your wishes known, including:
- Discussing with your family physician.
- Discussing with your family or designated next-of-kin, naming a Substitute Decision Maker; and putting your wishes in writing and having someone witness it.
- Obtaining an Advance Health Care Directive booklet (PDF) from the provincial government, or acute and long-term care sites at Eastern Health and complete it.
- As previously referenced, upon admission to hospital or a long-term care facility, discussing your wishes with a nurse, physician or social worker who will document your wishes as part of your medical record.
How can I protect my advance care plans?
Once you have completed your plan, give copies of your plan to your doctor and those who are close to you, including your substitute decision maker, and also keep a copy for yourself in an accessible place.
When is an advance care plan used?
Your plan is only used if you are unable to make your own health-care decisions (i.e. you are in a coma or your illness has impaired your ability to make decisions). Your substitute decision-maker can use it to guide your care and express wishes on your behalf.
How can I prepare to make these critical health-care decisions about my future care?
- Think about what’s most important to you about your end-of-life care.
- Get the information you need to make informed choices about health-care treatments and interventions. Become familiar with end-of-life care services available to you such as hospice and palliative care
- Talk to your doctor or health-care team about different treatments and what you can expect from those treatments, and to ensure you have accurate medical information. Make a list of questions in advance.
- Choose someone to become your Substitute Decision Maker (SDM).
- Record your end-of-life wishes – prepare an advance health care directive.
- Review your plan regularly. Your AHCD will only be used if you cannot speak for yourself and can be changed by you at any time to reflect evolving needs, goals and values.
Can an advance care plan be changed?
Yes, your plans can be changed by you at any time. Your life situation, medical conditions and the people around you – change over time. You should review your advance care plan regularly and revise it, if necessary, to be sure it continues to reflect your wishes, in consultation with your substitute decision-maker.
If you do make changes, give copies of the new plan to your health care providers, substitute decision-maker, and family and friends.
By documenting, your family members and health-care team will be able to make treatment decisions based on your values and wishes.