Advanced Care Planning: Top Four Considerations for Physicians in RQHR

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Advanced Care Planning: Top Four Considerations for Physicians in RQHR

21-Jun-2017

As a physician in the RQHR, you will regularly encounter patients that would benefit from an Advanced Care Planning/Goal of Care discussion. Sometimes these conversations can be challenging; the beginning point is having the discussion with your patient. Some key considerations as you move forward are:

  1. My Voice for Life-Sustaining Treatment Order (MVLST) Goals of Care

As part of Patient and Family Centered Care, it is the patient who now decides on their Goals of Care following a discussion with a Health Care Professional. The My Voice for Life-Sustaining Treatment (MVLST) Goals of Care Person Order replaces the Physician Order for Goal of Care/DNR. Physicians continue to write specific orders that support the person’s Goal of Care, such as medications, treatments etc.

  1. Health Care Decision Making

At times there can be confusion related to who the legal health care decision maker is, whether an Advanced Care Directive is binding, and can family members change the Advanced Care Directive after the patient no longer has capacity, etc. Legislation identifies the legal health care decision maker as the:

  1. Person with capacity
  2. Person’s Advance Care Plan and/or MVLST
  3. Substitute Health Care Decision Maker
    1. Proxy
    2. Personal guardian
    3. Nearest relative
    4. Two Health Care Professionals
  1. Proxy vs Power of Attorney

The identified Power of Attorney is not always the legal substitute health care decision maker. Most Power of Attorney documents do not define healthcare decision makers. The Power of Attorney document must be reviewed to determine this.

 

Proxy

Power of Attorney

·        Health care decision making

·        Finances and property

The Act reads:

“’proxy’ means a person appointed in a directive to make health care decisions for the person making the directive” (p. 3)

 

The Act reads:

“An enduring power of attorney granted in accordance with The Powers of Attorney Act, 2002.does not give the attorney the authority to make health care decisions pursuant to this Act” (p. 11).

Source: The Health Care Directives and Substitute Health Care Decision Makers Act, 2017 (The Act)

  1. The Right Goal of Care at the Right Time

The RQHR is committed to delivering health services from the patient’s perspective by providing an opportunity for persons with capacity, aged 16 and over, to participate in the identification of Goals of Care for treatment. In order to ensure people receive the best possible healthcare experience, it is important for them to choose the right Goal of Care at the right time.

The RQHR identifies four Goals of Care: Full Treatment (FT), Full Treatment Conditional (FTC), Limited Additional Interventions (LAI), and Comfort Measures Only at the end of life (CMO). FT and FTC are the two Goals of Care that are lifesaving whereas LAI and CMO are conservative management of a person’s medical condition.

Experience tells us that the majority of people fall into two of the four Goals of Care: FTC and LAI. FT is often chosen by people with strong cultural or spiritual affiliations while CMO is best suited for those nearing the end of their natural life.

Now available on RQHR YouTube

RQHR YouTube Public Video

Link: https://youtu.be/a5kqKEqMlJ4

Contact Information

Advance Care Planning
306-766-5922 or email: advancecare@rqhealth.ca

Links

RQHR Intranet
http://rhdintranet/AdvanceCarePlanning/Default.htm

RQHR Internet
http://www.rqhealth.ca/departments/advance-care-planning