Helping patients make 'End of Life' decisions

[cougarnurse]

This is a good read: Helping Patients Make End-of-Life Decisions - Oncology Nursing News

The controversy surrounding end-of-life-care provisions in the healthcare reform bill circulating through Congress may have left at least some practitioners unsure of where their patients stand on such matters. According to study results gathered by another part of the government—the Agency for Healthcare Research and Quality (AHRQ)—dying patients and their families maintain that lack of communication with healthcare providers causes confusion about medical treatments, conditions, prognoses, and the choices that the patients and families need to make.

This is just one of the findings that the AHRQ has compiled as part of its report for practitioners, Advance Care Planning: Preferences for Care at the End of Life (www.ahrq.gov/research/endliferia/endria.htm). This research is designed to help healthcare professionals assist their patients with advance-care decisions. The agency notes that although it's impossible to predict the needs and wishes of an individual dying patient, the research presented in the report can help providers offer end-of-life care based on preferences expressed by a majority of individuals in similar circumstances.

A 5-Step Discussion Process
The AHRQ report is divided into 2 sections. Section 1 presents findings from numerous studies, some of which were funded by AHRQ. For example, less than 50% of the severely or terminally ill individuals studied had an advance directive in their medical record, and between 65% and 76% of physicians whose patients did have an advance directive were unaware that such a document existed—perhaps because only 12% of patients with an advance directive worked with their physicians to develop it.

Section 2 includes charts and tables showing the quantitative results of the AHRQ studies.

One of the features of the document is a suggested 5-step process for discussing end-of-life care, created by AHRQ researchers. The main components of the framework are as follows:

1. Initiate a guided discussion, in part by sharing medical knowledge of hypothetical scenarios and treatments that reflect the patient's own situation.

2. Introduce the subject of advance-care planning and offer information, explaining that the patient should complete both an advance directive and a durable power of attorney.

3. Advise the patient to prepare and complete advance care planning documents, and ensure that they contain very specific instructions.

4. Review the patient's preferences on a regular basis and update documentation, reminding the patient that advance directives can be revised at any time.

5. Apply the patient's desires to actual circumstances—although it's often difficult for clinicians or families to determine at which point of illness to implement the patient's wishes, AHRQ research shows that patients choose treatment based on the quality of the prospective health state, the invasiveness and length of treatment, and possible outcomes.

The AHRQ notes in its report that by discussing advance-care planning during routine outpatient visits or hospitalization for exacerbation of illness, or when death appears to be near, clinicians can improve the person's satisfaction with care and provide end-of-life care that meets his or her wishes.
From the October 2009 Issue of ONN