Saturday, February 4, 2023

Advance Care Planning

Advance Care Planning are conversations between a patient, family or healthcare agent, and a healthcare provider about future healthcare decisions that may need to be made if the patient is suddenly ill or injured and unable to make their own medical decisions. These discussions will often result in Advance Directives which are written documents naming a medical power of attorney, directing the type of care one wishes to receive through a living will, or implementing transportable medical orders if the patient has an advanced disease.

The first Advance Care Planning conversation may occur when the patient is younger and healthier. It will likely be a conversation with the patient, a potential healthcare agent and a healthcare professional or trained volunteer. The goal of this conversation is to establish who the patient wants as a medical power of attorney and how they would want to be cared for if they were suddenly ill or injured, unlikely to recover and unable to express their wishes. 

A more detailed conversation should take place with a patient at the time of a serious injury or illness diagnosis. This conversation will include the patient, the healthcare agent if already named in a medical power of attorney or the family member identified as the legal surrogate decision maker under South Dakota Law, and a healthcare provider. This conversation will focus on the patient’s values, hopes, worries, and goals for future healthcare as they live with this serious illness or injury. One may be referred to a palliative care specialist at this time.

As the patient’s condition worsens or a terminal diagnosis occurs, additional conversations take place with the patient, if able, the legal surrogate/healthcare power of attorney and a provider or palliative care specialist. These conversations will focus on symptom management, benefits and burdens of care options and how this relates to the patient’s overall goal and creating transportable medical orders when appropriate. 

Below, you will find documents used in South Dakota, tools to help you with the advance care planning conversations and some organizations that help with training, promoting and documenting advance care planning. 

Durable Power of Attorney for Health Care: A document where a person (the principal) appoints another person (the healthcare agent) to make healthcare decisions should the principal lose capacity to make their own decisions.
South Dakota does not have a standardized form for power of attorney for healthcare. Check with your healthcare system to see what forms they have created that meet the requirements to address artificial nutrition and hydration SDCL 59-7-2.7
Living Will: A document created by a person that instructs healthcare providers on the type of life sustaining treatment to be provided, withheld, or withdrawn under specific conditions. It does not name a person to be a surrogate decision maker. If the person only has a Living Will, healthcare providers will need to follow South Dakota Health Care Consent Law SDCL 34-12C-3 to identify the legal surrogate decision maker. The South Dakota Living Will document can be found here.
Comfort One: “A medical order based on informed consent, signed by or on behalf of an individual and a physician, a physician assistant or a nurse practitioner, directing emergency medical services personnel to NOT perform resuscitative measures in the event of a respiratory or cardiac arrest or malfunction.”
To obtain the triplicate form please contact the South Dakota Department of Health here. SD MOST: A standardized medical provider’s order valid across all care settings and in facilities, including the home.  Medical orders contained in this document reflect the patient's wishes for healthcare once they have been diagnosed with a terminal illness or reach the end stage of a chronic, progressive illness. For more specific information on MOST or to download the form go to sdaho.org/MOST.
Here are links to discussion tools to help you facilitate a shared decision-making conversation with your patients:
Respecting Choices: “Respecting Choices is a well-established, not-for-profit organization committed to guiding organizations and communities as they integrate and disseminate best practices to ensure that individuals’ preferences and decisions for healthcare are known and honored”.  For more information on this program visit respectingchoices.org.
National Healthcare Decisions Day (NHDD):  A program of the Conversation Project, is held annually on April 16.  “It exists to inspire, educate and empower the public and providers about the importance of advance care planning”. For information on how your organization can participate in NHDD visit theconversationproject.org/nhdd.
“WiserCare’s personalized decision-making platform combines patient preferences and goals with key clinical information to support and automate smarter choices in less time.”  For more information go to  www.wisercare.com.
Works with insurance companies to provide advance care planning to those with serious illness.  For more information go to vitaldecisions.net.
Soon to be nationwide-online advance care planning platform provides a simple, guided, and personalized experience for patients to complete their ACP. For more information go to kodahealthcare.com