Advance Care Planning Goals of Care Calgary Zone

Advance Care Planning: Goals of Care Calgary Zone (403) 943 -0249 http: //www. albertahealthservices. ca/advancecareplanning. asp myvoice@albertahealthservices. ca

Advance Care Planning: Goals of Care - Calgary Zone Advance Care Planning is a process that involves: • • Thinking about values and wishes regarding future health care choices; Learning about medical information that is relevant to health concerns, understand prognosis, potential degrees of benefit and possible burdens; Choosing an agent and communicating wishes and values to your agent, loved ones, and health-care providers, and; Documenting wishes and values and sharing these documents with your agent, loved ones, and health-care providers. 2

Who needs to engage in Advance Care Planning? Everyone. You never know when you may face an unexpected event or illness and will be unable to make your preferences known. 3

Why should I consider Advance Care Planning? • Health-care decision-making can be very complex. It may be easier to make decisions when you have thought about and shared your values and beliefs ahead of time. • Advance care planning and completing a personal directive can ease the burden on your loved ones by helping them understand your wishes so they can confidently speak on your behalf, should you be unable to do so. 4

Why should I consider Advance Care Planning? According to Statistics Canada: • 248, 000 Canadians die each year • In 2020 this number will have increased to 330, 000 According to the Canadian Hospice and Palliative care Association : • Up to 50% of persons cannot make their own decisions at the end of life (CHPCA) • Health professionals typically treat when uncertain of treatment wishes • Hospitals remain the major provider of EOL care as 70% of Canadians die in a hospital with one in five of these hospitalized deaths occurring in an ICU • Loved ones have a significant chance of not knowing a person’s view without discussion 5

Why should I consider Advance Care Planning? Current Research demonstrates: • The absence of Advance Care planning is associated with worse patient and family ratings of quality of life in the terminal phase of illness. • Conversations are difficult for everyone • Those who have end of life conversations with loved ones and health care professionals: • Require fewer aggressive medical interventions at the end of life • Are more likely to take advantage of relevant resources at end of life • Surviving family feel less of a burden with decision making and have reduced suffering/distress in times of bereavement. 6

Advance Care Planning: Goals of Care Designation (Adult) Policy Calgary and Area If you have a medical condition: • What do you know about your health condition? • Do you know the treatment decisions you may need to make in the future? • What procedures would you want/not want if you were to have a medical emergency? 7

Planning Documents Decisions made by you… Decisions made by the court …while you are alive Personal Directive Agent Co-Decision-making Co-decision Maker Supported Decision Authorization Supporter Guardianship Guardian Enduring Power of Attorney Trusteeship Trustee Personal Decisions Financial Decisions …after death Will Intestate Succession Act The court would only award guardianship or trusteeship if a person was incompetent, and had not Financial Assets Executor Administrator written a Personal Directive or an Enduring Power of Attorney. For more information go to http: //www. seniors. alberta. ca/opg * Graphic used with permission by the Office of the Public Guardian 8

Advance Care Planning: Goals of Care Designation (Adult) Policy Calgary and Area Choose someone… To speak on your behalf, who: • Is at least 18 years old • Will respect your values, beliefs and goals • Communicates well with family and healthcare providers • Agrees to be your representative (This person would be called your Agent if you name them in your Personal Directive) 9

Document your preferences… in a Personal Directive. Give copies to: • Your Agent • Your healthcare providers • Your family • Others Ask them to bring your documents to the hospital if you are admitted. 10

Preparing your documents • What documents have you completed? (Personal Directive, “My Voice” workbook, Enduring Power of Attorney, Will) • Have you given copies of your documents to those people who should have them? (physicians, Agent, family, friends, etc. ) • When is the last time you reviewed these documents? Do they need to be updated? Are there any changes you want to make? 11

Review and revise… your advance care plan: • When there is a change in your health status • When there is a change in your treatment location • When new information is available • Annually 12

Goals of Care A Goals of Care Designation is a letter/number code that provides direction regarding specific health interventions, transfer decisions, locations of care, and limitations on interventions for a patient as established after consultation between the Most Responsible Health Professional and Patient. 13

Goals of Care • Health care goals established through Advance Care Planning conversations between the individual, family and any members of the health care team. • Align appropriate medical interventions with individual wishes and values. 14

Goals of Care Conversations’ Core Elements § Diagnosis and prognosis § Individual’s values, hopes, and expected outcomes § Life support interventions and life sustaining measures and anticipated degree of benefit and/or burden § Comfort measures § Decision support resources such as social work, spiritual care, and palliative care § Goals of Care Designation 15

Goals of Care • Clinician’s Perspective • Cure of a condition to restore functioning • Control of a condition in order to maintain function • Alleviation of symptoms, such as pain or discomfort 16

Goals of Care Individual’s Perspective • What are my hopes for the treatments being considered? • What are the benefits and burdens of a treatment? • How do my values, goals and beliefs impact my decision for: −Living as long as possible −Having better quality of life −Being independent −Controlling symptoms −Where to be cared for 17

Goals of Care 1. Engage in Goals of Care Conversation − Medical condition prognosis − Individual's values and hopes − Life support interventions, life sustaining measures and degree of benefit − Comfort measures − Decision support − Goals of Care Designation 18

Advance Care Planning: Goals of Care - Calgary Zone Process of arriving at a Goals of Care Order • • • R Medical Care and Interventions including Resuscitation followed by ICU M Medical Care and Interventions, excluding Resuscitation C Medical Care and Interventions, focused on Comfort • • Diagnosis Prognosis Anticipated Outcomes Wishes and Values Life Support / Life Sustaining Benefits Comfort Measures Resources • • • Cure or control of condition with option for resuscitation Cure or control, no resuscitation Alleviate the symptoms 19

Advance Care Planning: Goals of Care - Calgary Zone 20

Goal of Care - R • R 1 - Patient is expected to benefit from and is accepting of all appropriate interventions and investigations including resuscitation and ICU care • R 2 - Patient is expected to benefit from and is accepting of all appropriate interventions and investigations including resuscitation and ICU care with the exception of chest compressions • R 3 - Patient is expected to benefit from and is accepting of all appropriate interventions and investigations including resuscitation and ICU care with the exception of chest compressions and intubation 21

Goal of Care – M • M 1 – Interventions are for cure or control of illness excluding ICU and Resuscitative care. Transfer to hospital considered if required for diagnosis and/or treatment • M 2 – Interventions are for cure or control of illness, excluding ICU and Resuscitative care. Transfer to Acute care and/or surgical intervention not generally undertaken for acute deterioration but may be considered in special circumstances to better understand or control symptoms. 22

Goal of Care – C • C 1 – Maximal symptom control and maintenance of function with cure or control of underlying condition. Transfer and/or surgery to better understand or control symptoms. • C 2 – Physical, psychological and spiritual preparation for imminent death. Maximal efforts directed at compassionate symptom control. Transfer usually not undertaken. 23

Goals of Care • A Goals of Care Designation Order is reviewed: • Acute Care: every 30 days. • LTC/DAL/HC: every 12 months. • If patient is transferred between health care teams • If there is a significant change in health status. • At the request of the individual or representative. 24

Questions? For more information: Call us at (403) 943 -0249 Visit our website: http: //www. albertahealthservices. ca/advancecareplanning. asp Email us at: conversationsmatter@albertahealthservices. ca 25