guidelines for advance directive discussion

Introduction

opening statement

Many elderly people think about serious illnesses in the future, & wish to discuss in advance the kind of health care they want if they lose the ability to make decisions for themselves. Can we discuss some of these issues today?

goals

• provision of intervention & outcome information
• clarification of patient values
• setting goals for care in case of future incapacity
  • comfort vs. life prolongation for terminal illness
  • when would patient want comfort measures only?
  • specific intervention preferences
    • CPR
    • hospitalization
    • ventilator (acute vs. chronic)
    • hospitalization
    • tube feeding
    • IV
    • transfusions
    • antibiotics
• the main goal is not to 'get code status'
• naming of proxy decision maker

factors to consider in advance care planning

• quality of life prior to an intervention
• the intervention itself
  • prognosis
  • cost
  • burden
• quality of life after the intervention
• other common patient considerations
  • family burden & costs
  • 'dignity'
  • attitudes toward responsibility to the young
  • 'deciding not to decide' - prefers others to decide
  • concerns about the way death occurs vs. death itself

assessment of competency to complete advance directives

see Hopkins Competency Assessment Test

Additional terms

• advance directives
• Hopkins Competency Assessment Test (HCAT)