7. Advance Care Plans

In this final section, we will turn our attention to advance care planning to become more familiar with advance care plans and directives as they relate to end of life care.

Patients have an opportunity to spell out autonomous decisions in a Personal Healthcare Directive or Advance Care Plan (Living Will). These legal documents outline a patient’s wishes should they be unable to speak for themselves. Every medical professional should educate themselves on these documents. If they are completed sensitively and in depth they can provide critical information on a patient’s values, beliefs and end of life wishes. Any ambiguities should be clarified directly with the patient while they are fully coherent.

Initiating such conversations with patients and families is difficult. However, we face end of life issues throughout our careers and learning effective communication strategies will not only enhance our professionalism, it will ease emotional pain and suffering for many patients and families.

A large Canadian multi-centre study of 500 elderly patients at “high-risk for dying” found that:

• over 75% of participants had thought about the type of end of life care they want
• over 90% of participants discussed their preferences with family members
• less than 30% had discussed these wishes with doctors

Unfortunately, this means family or friends are given the responsibility of relaying to medical staff what they believe the patient’s wishes to be. This frequently causes deep distress and feelings of guilt as loved ones struggle to articulate what the patient’s wishes may have been. By the same token, palliative patients are often troubled by how their families will cope with their dying. The opportunity to clearly document their wishes with guidance from a medical professional will help to allay these fears.