Senior Director, Carilion Clinic Hospice
Roanoke, Virginia | Franklin, Virginia | New River Valley
Q: What is advance care planning?
A: Advance care planning goes beyond having a medical power attorney or a living will. Those documents INFORM your health care providers of your wishes but do not necessarily get translated into your medical chart as a physician’s order for care. Advance care planning is for the individual who has advanced stage or advanced medical conditions, such as cancer or kidney disease, and is facing difficult decisions about how they want to live the rest of their lives. A critical part of advanced care planning is having the conversation regarding life values and goals, i.e. the “what’s important to me” conversation.
Q: Why is advance care planning important?
A: Studies show advance care planning results in better patient quality of life, less patient depression, and better caregiver health and bereavement adjustment by family. Yet only about one-third of adults have an advance directive expressing their wishes for end-of-life care. Without advanced care planning, surrogate decision makers and physicians face doubt and uncertainty in what the patient’s goals and objectives of care are. These may result in unwanted default care or treatments and artificial life support.
Q: What are the steps in advance care planning?
A: First, learn about the condition, options in care, and likely outcomes of the care options.
Second, the patient needs to consider the options with his/her goals in mind. Goals can include maximizing longevity to preserving quality of life and/or having a meaningful recovery. Decisions about medical care should include conversations about life support beyond CPR, dialysis, artificial nutrition
(feeding tube), artificial fluids, breathing machines (ventilators), and comfort care. Clinicians may refer the patient to specialty providers in palliative medicine and hospice for those who choose soothing and alleviation of symptoms that develop with advanced illness.
Third, communicate decisions to family and/or caregivers and generate doctors’ orders to ensure those goals of care are respected during care. These goals include accepting aggressive treatments, pursuing treatments that promote comfort, dignity, and peace, or terminating specific treatments.
Q: What resources are available to me to begin advance care planning?
• American Bar Association’s: Consumer’s Toolkit for Health Care Advance Planning
• Caring Connections from the National Hospice and Palliative Care Organization: End of Life Decisions
• For these links and others, please visit CarilionClinic.org/hospice
Lisa T. Sprinkel, MSN, RN is Senior Director for Carilion Clinic Home Health and Hospice. Lisa supports local and state home health and hospice initiatives, including Advanced Care Planning education.
TF: 800-964-9300 • Web: CarilionClinic.org/hospice