Advance care planning: Beyond the living will

Abstract

For a variety of reasons, the most commonly used advance directive documents (eg, the living will) may not be very useful in many situations that older adults encounter. The durable power of attorney for health care is a more versatile document. We advocate focusing less on "signing away" certain interventions and more on clarifying the goals of care in the ambulatory setting.

Advance directives or living wills: reflections of general practitioners and frail care coordinators in a small town in KwaZulu-Natal

“…[17][18][19] Research also points to the value of physician-initiated advance care planning as a means to increase uptake. This suggests that it may be time for doctors and nurses to meet their patients halfway by embracing their role of initiating advance care planning.…”

The misleading simplicity of advance directives

“…Yet, notwithstanding this failure, what the practice of advance directives does demonstrate is the relevance for health professionals to invest in helping people to plan ahead, specifically those who are facing a future of uncertainty with a high risk for incapacity, such as patients diagnosed with dementia and their families. The challenge now is to move on from static documents to a more dynamic practice of advance care planning, defined as a dialogical process of supporting patients and their proxies to think ahead and formulate goals of care as they confront the challenge of a progressive illness trajectory (Messinger-Rapport et al, 2009;Gillick, 2010, Hertogh, 2010. Such advance care planning should start early and must be firmly rooted in doctorpatient communication.…”

Developing a Taxonomy and Mapping Concepts of Shared Decision Making to Improve Clinicians Understanding

“…Studies have found that when appointing a guardian or proxy decision maker, there should be structured conversations about values and preferences to ensure the guardian in properly informed. 72 This same study recommended that these interactions should be safeguarded with oral, written and video recorded information to be used for future decision making. Caution should be taken in the decisions made by guardians if their relationship is that of caregiver, especially if there are economic burdens associated with care.…”