Advance Care Planning - The Nuts & Bolts

Learn about the importance and process of advance care planning in this physician grand rounds presentation. Explore the impact of advance care planning on end-of-life care for elderly patients, including findings from a randomized controlled trial. Discover how to select a health care agent, consider personal priorities and spiritual values, and navigate difficult conversations about end-of-life decisions. Gain insights into identifying values based on past experiences and quality of life, choosing surrogates wisely, and informing family and friends about one's wishes to prevent conflicts. Understand the key components of effective advance care planning and how to implement them in clinical practice.

Intro
Advanced Care Planning: The nuts and bolts
The impact of advance care planning on end of life care in elderly patients: randomized controlled trial • Respecting Patient Choices Program Victoria Australia • 309 inpatients age 80 and followed for 6 months • Program based on Respecting Choices v standard care - N=125/154 received plan and 86% expressed their wishes about end of life care, 82% expressed wish about CPR and 75% about life prolonging treatment • 92% wishes were followed up to time of death • Satisfaction at discharge - Overall 93% 65%
How to Select Your Health Care Agent • Are Some Conditions Worse than Death? • How Do You Weigh Odds of Survival? • Personal Priorities and Spiritual Values After Death Decisions to Think About Now • Conversation Scripts: Getting Past the Resistance • The Proxy Quiz for Family and Physician • What to Do After Signing Your Advance Directive • Guide for Health Care Proxies
Identify values based on past experiences and quality of life . Choose surrogates wisely and verify that they understand their role • Decide whether to grant leeway in surrogate decision making • Inform other family and friends of one's wishes to prevent conflict