Advance Care Planning

Background

A significant part of health care involves caring for people who are facing the end of their life. The Goals of Care Team aims to improve Alberta Health Services' ability to deliver quality care at the end of life to patients and their families in all health care settings.

How and where people died over the last 30 years has changed dramatically. Now, two out of every three individuals will die with one or more serious chronic illness. Frailty due to conditions such as such dementia, cardiovascular disease, Renal and Parkinson's Disease will shape the last years of life for the majority of us. We may be sick enough to die but live many years. Yet at this time, the health care system is not well situated to ensure quality care at the end of life.

Traditionally, care at the end of life has been predominantly viewed as a service for cancer patients with a course of illness characterized by a fairly predictable terminal phase and who are under the care of palliative and hospice care services. However, death due to cancer accounts for 25 - 30 percent of the total deaths within Alberta Health Services.

To address the gaps in quality care at the end of life, the Goals of Care Team is focusing on four major objectives:

Systematize consistent ideal practice in Advance Care Planning
Develop policies related to end of life care that are standardized across AHS and support best practice for care at the end of life
Extend end of life care to a broader patient population
Promote planning that includes end of life care with all program services

View our Logic Model

Health Canada

http://www.hc-sc.gc.ca/index-eng.php

Advance Care Planning Example

It’s 2:00 am. An elderly man with end-stage hepatic failure has arrived at hospital with an infection and a high fever that has made him delirious. The medical team knows that life-sustaining medical interventions will not contribute to the patient’s recovery and they wish to provide expert, compassionate care. The patient is unable to communicate his wishes and his family members are distressed. They are unable to agree on what their father would want as they have never discussed these questions with him.

Consultations with physicians and health care providers across the Calgary area indicate that there are many opportunities to improve care at the end of life. By far, the most pressing need identified was to develop a system of advance care planning.

Currently it’s challenging to engage patients and families in discussions that empower them to make informed choices about issues such as hydration, tube feeds, ventilation, CPR and other life-sustaining treatments. These discussions are often left for when patients and families are in crisis and least equipped to make these decisions.

One of the main objectives of the Goals of Care Team is to make it easy and normalized for people – in consultation with their health care providers, family members and other important people in their life – to reflect in advance for what life-prolonging medical treatment they would or would not want.

Developing a system of advance care planning within Alberta Health Services - Calgary Area

To create a culture of advance care planning, AHS - Calgary began by learning from the Respecting Choices® Advance Care Planning model, developed by Gundersen Lutheran Medical Foundation in Wisconsin, USA. The program teaches health care providers to have facilitated conversations with patients and their families about future medical decisions, incorporating the patient's values, goals, relationships, culture and religion. These choices are then clearly documented within health records so they are available when needed. Whether a patient is in the Emergency unit, at home, in a long term care centre or being transferred from one health care setting to another, their decisions on how they want to be cared for will be accessible to attending clinicians. "My Voice - Planning Ahead" is the AHS - Calgary Advance Care Planning program. Advance care planning is a process of assisting individuals to:

Understand their medical condition and potential future complications
Understand the options for future medical care as it related to their current health condition or to emergency medical situations
Reflect on their goals, values and personal beliefs
Consider the benefits and burdens of current and future treatments
Discuss choices with family / important others and health providers and document these choices

Background

Background to the Advance Care Planning: Goals of Care Designation (Adult) Policy and Implementation Overview

Advance Care Planning Home Current Highlights Advance Care Planning: Goals of Care Designation Policy Background Advance Care Planning Tools Goals of Care & Goals of Care Designations Forms & Processes Education Resources FAQ's Related Publications, Reports & Research Pediatrics Links Contact Us	Advance Care Planning Background A significant part of health care involves caring for people who are facing the end of their life. The Goals of Care Team aims to improve Alberta Health Services' ability to deliver quality care at the end of life to patients and their families in all health care settings. How and where people died over the last 30 years has changed dramatically. Now, two out of every three individuals will die with one or more serious chronic illness. Frailty due to conditions such as such dementia, cardiovascular disease, Renal and Parkinson's Disease will shape the last years of life for the majority of us. We may be sick enough to die but live many years. Yet at this time, the health care system is not well situated to ensure quality care at the end of life. Traditionally, care at the end of life has been predominantly viewed as a service for cancer patients with a course of illness characterized by a fairly predictable terminal phase and who are under the care of palliative and hospice care services. However, death due to cancer accounts for 25 - 30 percent of the total deaths within Alberta Health Services. To address the gaps in quality care at the end of life, the Goals of Care Team is focusing on four major objectives: Systematize consistent ideal practice in Advance Care Planning Develop policies related to end of life care that are standardized across AHS and support best practice for care at the end of life Extend end of life care to a broader patient population Promote planning that includes end of life care with all program services View our Logic Model Health Canada http://www.hc-sc.gc.ca/index-eng.php Advance Care Planning Example It’s 2:00 am. An elderly man with end-stage hepatic failure has arrived at hospital with an infection and a high fever that has made him delirious. The medical team knows that life-sustaining medical interventions will not contribute to the patient’s recovery and they wish to provide expert, compassionate care. The patient is unable to communicate his wishes and his family members are distressed. They are unable to agree on what their father would want as they have never discussed these questions with him. Consultations with physicians and health care providers across the Calgary area indicate that there are many opportunities to improve care at the end of life. By far, the most pressing need identified was to develop a system of advance care planning. Currently it’s challenging to engage patients and families in discussions that empower them to make informed choices about issues such as hydration, tube feeds, ventilation, CPR and other life-sustaining treatments. These discussions are often left for when patients and families are in crisis and least equipped to make these decisions. One of the main objectives of the Goals of Care Team is to make it easy and normalized for people – in consultation with their health care providers, family members and other important people in their life – to reflect in advance for what life-prolonging medical treatment they would or would not want. Developing a system of advance care planning within Alberta Health Services - Calgary Area To create a culture of advance care planning, AHS - Calgary began by learning from the Respecting Choices® Advance Care Planning model, developed by Gundersen Lutheran Medical Foundation in Wisconsin, USA. The program teaches health care providers to have facilitated conversations with patients and their families about future medical decisions, incorporating the patient's values, goals, relationships, culture and religion. These choices are then clearly documented within health records so they are available when needed. Whether a patient is in the Emergency unit, at home, in a long term care centre or being transferred from one health care setting to another, their decisions on how they want to be cared for will be accessible to attending clinicians. "My Voice - Planning Ahead" is the AHS - Calgary Advance Care Planning program. Advance care planning is a process of assisting individuals to: Understand their medical condition and potential future complications Understand the options for future medical care as it related to their current health condition or to emergency medical situations Reflect on their goals, values and personal beliefs Consider the benefits and burdens of current and future treatments Discuss choices with family / important others and health providers and document these choices Background Background to the Advance Care Planning: Goals of Care Designation (Adult) Policy and Implementation Overview
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