Have a say in their health care Objectives The who , what , where , - PowerPoint PPT Presentation

Helping your patients Have a say in their health care

Objectives • The who , what , where , when and how of ACP • ACP resources &WRHA ACP policy • ACP definitions t he heir

Advance Care Planning (ACP) • the overall process of dialogue, knowledge sharing, and informed decision-making that needs to occur at any time when future or potential life threatening illness treatment options and goals of care are being considered or revisited. t he heir

What is Advance Care Planning (ACP)? • ACP is process of communication between the patient/substitute decision maker and the health care team. • ACP goals of care discussions should take place in advance of anticipated deterioration or acute illness including surgery. t he heir

Health Care Directive • Is a Manitoba document that originates from the Health Care Directives Act. • A legal document (sometimes referred to as a “living will”) used to capture an individuals wishes for medical care and treatments • Recognizes mentally capable individuals have the right to consent or refuse to consent to health care treatment

Health Care Directive • Indicates that these wishes should be respected even after the individual is no longer able to participate in decisions regarding their health care treatment • Individual writes their instructions about the treatment they would accept or refuse • Names a proxy to speak for the individual if they are unable to speak for themselves

What is a Proxy? • Is someone you choose and name in your directive to act for you in the event you are not able to make such judgments and speak on your own behalf. • It is not possible to anticipate every set of circumstances, your proxy has the power to make health care decisions for you based on what you have told your proxy about your wishes and the information in your directive.

Proxy/Substitute Decision Maker • refers to a third party identified to participate in decision making on behalf of an individual who lacks capacity. • the task of the substitute decision maker is to faithfully represent the known preferences, or if the preferences are not known, the interest of the individual lacking capacity. t he heir

Capacity • An individual has capacity to make health care decisions if s/he is able to understand the information that is relevant to making a decision & able to appreciate the reasonably foreseeable consequences of a decision or lack of decision. t he heir

Becoming an organ & tissue donor • Compassionate end of life care and the opportunity for organ donation is the right of every Manitoban, and the responsibility of all members of the donation and healthcare team. • Individuals should consider if organ and tissue donation is important to them, talk with their families about their decisions and register their intent to be a donor at www.signupforlife.ca. • Registration takes two minutes and requires three pieces of information – name, birthdate and nine-digit number on your Manitoba Health card.

Becoming an organ & tissue donor • Nearly everyone has the potential to be an organ and tissue donor. The health of the donor, not the age, is the most important consideration. • Organ donation occurs after brain death. Everyone is encouraged to discuss their final wishes with their families in a calm setting, not during a crisis. Families are required to provide consent on behalf of the patient, so it is important for families to know how to honour donation decisions. • For more information, visit www.transplantmanitoba.ca or contact the program at 204-787-1897.

WRHA Advance Care Planning Goals of Care • An inpatient form used to recorded agreed upon goals of care reached through full & completed ACP discussion with Patient and /or Substitute Decision Maker/Proxy t he heir

Understanding the Differences Health Care Directive WRHA Advance Care Plan Goals of Care Form Protected by legislation Policy driven Initiated by the person Initiated by the health care team Completed only if person is competent Enables discussion with family where person is no longer competent Legally binding document Consensus based document

Goals of Care • the intended purposes of health care interventions and support as recognized by both a patient or substitute decision maker and the health care team • on the goals of care form, three options exist: = Comfort care excluding attempted resuscitation = Medical care excluding attempted resuscitation = Medical care including attempted resuscitation t he heir

Goals of Care • Comfort Care (C) – interventions are directed at maximal comfort, symptom control, and maintenance of quality of life. Attempted Cardiopulmonary Resuscitation [CPR] (trying to restart with heart after it has stopped beating) will not be tried. • Medical Care (M) - interventions are for the usual medical care that is appropriate to treat and control the patient’s condition. The consensus is that the patient my benefit from, and are accepting of, any appropriate investigations / interventions that can be offered. Attempted CPR will not be offered. t he heir

Goals of Care • Resuscitation (R) – interventions are for the usual medical care that is appropriate to treat and control the patient’s condition. The consensus is that the patient my benefit from, and are accepting of, any appropriate investigations / interventions that can be offered, including attempted CPR. t he heir

Key Questions And Resources he t heir

Who can initiate an ACP discussion? • All members of the health care team can initiate the discussion • Key members of the health care team that often have these discussions include social workers, case coordinators, physicians, nurses, etc. • Patients & their family can also initiate the discussion t he heir

Who needs to be involved in an ACP conversation? • The patient, or substitute decision maker The patient may also choose others to participate Member or members of the health care team The Health Care Team may involve others as appropriate t he heir

When would I initiate a conversation? ACP discussions will be initiated whenever future treatment options or goals of care need to be considered or revised, regardless of facility, site or community location. t he heir

When & where would I initiate a conversation? • It may be appropriate to have these conversations routinely on admission (e.g. PCH) or even prior to admission (e.g. in pre-operative assessment clinic). • Patients who have an existing ACP will have their old forms converted to the new advance care planning goals of care format with their next care plan review. • Review or complete form before Home Care or Palliative Care client is being transferred to hospital. t he heir

What if a patient requests to review their Goals of Care? • The health care team will respond within 72 hours or sooner if the patient’s clinical situation warrants more immediate attention as per policy 110.000.200 t he heir

Things to consider when starting an ACP conversation The health care team shall ensure that the patient / substitute decision maker receives full and complete information about: • the nature of the individual’s current condition • prognosis • treatment options including benefits / burdens resources for patients: ACP patient Workbook, discussion with members of the health care team and online

What techniques would I use to participate in these conversations? • Therapeutic communication techniques are essential in ACP conversations. • Helpful tips, suggestions and other ACP communication resources are available online.

English is not my patient’s first language. What Can I Do? The health care team must request the services of a trained health interpreter when patients have limited English proficiency (call 788- 8585)

What additional resources are available? • Regional ethics • Social Work • Indigenous Health • Spiritual care • Patient representatives • Clinical experts • ACP patient workbook Health care team needs to make certain the patient is aware of these resources

What happens if consensus cannot be reached? • all available resources should be used in attempts to reach consensus • if consensus cannot be reached, the “advance care planning - goals of care” form will not be completed • in such situations, health care professionals will continue to be guided by the standards of practice of their respective regulatory bodies t he heir

Supporting Documents • WRHA advance care planning goals of care form Policy:110.000.200

Supporting Documents • ACP patient workbook

How to complete an ACP Goals of Care Form • First, the health care team shall ensure ACP goals of care discussions occur prior to the completion or revision of the “ACP - Goals of Care” form. t he heir

What if a Health Care Directive already exists? A valid Health Care Directive that is completed by a patient will be respected unless requests made within the Health Care Directive are not consistent with accepted health care practices. t he heir