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A=Advance Care Planning (ACP)
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
- 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?
A=Advance Care Planning (ACP)
- Identify barriers to advance care planning with patient and family
- Provide written and verbal information to patient and family
- Maintain current knowledge of your institutions policies and your states regulations related to Advance Care Planning: (i.e. New York)
- New York State recognizes three types of advance directives: New York State Healthcare Proxy, Living will and Do Not Resuscitate Order (DNR), MOLST Form
- “Planning your healthcare in advance”, a 31 page guide with advance directive forms
- Clarify the patient’s understanding of their illness and treatment options
- Determine/recognize/understand the patients values, beliefs and goals of care
- Provide written and verbal information about health care decision making to the patient and family
- Explore resuscitation issues with the patient and their health care designee & facilitate discussion with the health care team
- Facilitate completion of appropriate forms with provision to the appropriate care providers