Related Issues:
Advance Directive, DNR, Health care proxy, Living will, Medical power of attorney, Medical Orders for Life Sustaining Treatments (MOLST)
Why Advance Care Planning is Important:
- The Patient Self Determination Act of 1990 established that healthcare facilities were mandated to communicate to patients their right to make decisions about their care
- Advance directives document a patients’ wishes with respect to life sustaining treatment, their selection of a surrogate decision maker or both
- Promotes patient autonomy, and increases the likelihood that healthcare decisions will match the patients personal values and choices
- Eases the burden on families and health care providers when the patient is unable to make decisions for themselves
- A cancer diagnosis in the older adult may increase awareness of the need for an Advance Care Plan
- It is optimal to address Advance Care Planning prior to the initiation of treatment (chemotherapy, radiation, surgery)
Older adults are at increased risk of:
- Cognitive & functional decline
- Limited health literacy and/or functional health literacy (ability to read & comprehend prescriptions bottles, appointments, etc.)
- Having cultural, religious, spiritual issues misunderstood or not respected
- Not having discussed end of life care with their family or caregivers
- Being socially isolated
- Absent or abusive support systems
Assessment:
Screening Questions
- Do you have a completed health care proxy form or living will that reflects your current wishes?
- Have you discussed you wishes with your health care agent?
- Do you know who you would choose to make decision about your medical treatment if you were unable to make them for yourself?