Central PA Medicine Spring 2018 - 17

daup h i n c m s .o rg

What does advance care planning mean ACP is not just for the elderly; the living. If his doctors felt there was a reasonable
to you?
sandwich generation should not be chance to get him back to his current condition,
Are you aware of how important ACP is to overlooked.
then he wanted all the life sustaining treatment
your patients? 90% of patients say that talking
A physician in her 40s, guiding the care that was available. However, if his doctors felt
with their loved ones about end of life care is of her rapidly ailing father, was surprised there was little chance that he would recover to
important, and yet, only 27% have done so that the physician caring for her father did his current condition, he would elect comfort
(1. The Conversation Project National Survey, not bring up ACP. When the question was care. This letter serves as a legal document to
2013). 80% of people say that if seriously ill, raised by the family, her father's physician honor this patient's wishes.
they would want to talk to their doctor about seemed surprised, and stated, "I wish more
medical treatment at the end of life, yet only patients were unafraid to ask." As a result of Identifying the Right Person to Speak
7% report having such conversations (2. Survey a conversation about care, medications were for You Requires a Conversation.
of Californians by the California HealthCare stopped, and the patient had a beautiful last
A law professor completed an AD and
Foundation, 2012). One in ten Medicare few weeks of life surrounded by his family. named her daughter as her agent to speak for
patients has major surgery in the last week But whose responsibility is it to start such a her if she became unable to make or commuof life, yet 90% of physicians say they would conversation - the patient, patient's family or nicate her healthcare choices. When told, her
reject aggressive treatment at the end of their the physician?
daughter stated that she would never be able
own lives (3. Compassion & Choices Magazine,
to withhold or withdraw treatment from her
Summer 2016). Here in Pennsylvania, we have Daughters and sons may be just as mother. The professor then spoke to her son
lower than the already poor national average, reticent as their parents to start a con- about her wishes and he agreed to honor her
as less than 20% of Pennsylvania adults have versation about end-of-life care.
wishes. The professor destroyed the first AD
Advance Healthcare Directives (4. PA Medical
An aging patient who had endured multiple and created a new one naming her son as agent.
Society Survey, 2010).
rounds of chemotherapy was ready to opt for
comfort care and a natural death. His dilemma Individuals can have very different
What can we do to improve this within was how to broach the subject with his son perspectives based on their own values.
our communities?
who advocated for continued treatment. Dad
At a group conversation, one man expressed
We should aim to be more like La Crosse, asked his physician, "How do I tell my son it his desire to die at home. Another across the
Wisconsin, where the Gundersen Health is time to let me go?"
table said that dying at home was the last thing
System developed the gold standard Respecting
he wanted. The first wanted to be surrounded
Choices Program for ACP. Of patients who Patients may have more important goals by family and friends in a comfortable setting,
died in La Crosse County in 2010, 96% had than extending their lives.
the latter did not want his family to associate
an AD in their medical record and 99.5% of
A woman in her thirties had terminal stage 4 the home with his death. These sorts of
the charts document that the patient's choices breast cancer. She was on life-extending chemo differences make the conversations important
were honored. A side benefit has been the and radiation therapies. When the end was to have - not just once, but ongoing as life's
reduction of costs in the last two years of a near, she expressed her priority to keep her end approaches.
patient's life; in La Crosse, they are near the promise to her 10-year-old daughter to take
lowest in the nation (5. National Comparison: her to Disneyland. Her doctors listened - they It's easier than patients think to talk
www.dartmouthatlas.org). Conversations are stopped chemo and radiation therapies, built about ACP.
the key. A few stories will serve to illustrate back her immunity and stamina to the point "In our sixty years together, we've never talked
some basic tenants for physicians to consider. that she could keep her promise and take her about these things," agreed a couple after
daughter to Disneyland. On returning home, talking about three questions that are part of an
Each of us has the legal right to choose she restarted her treatments with the great ACP conversation. (1) What is an acceptable
the care we want.
peace of mind that she had kept her promise quality of life? (2) What is important to me
A priest who personally believed that hy- to her daughter.
for comfort and peace of mind? (3)
dration and nutrition should not be withheld,
tried to talk his 83-year-old cancer-suffering Advance Directives are not limited to a What special instructions do I want to
mother to let physicians insert a feeding tube. specific format.
tell my healthcare agent?
If a feeding tube were inserted, she insisted she
A paraplegic resisted completing an AD. The couple was pleased and grateful for the
would pull it out. Being capable of making and After many discussions with the social worker conversation and committed to completing
communicating her wishes, she prevailed. But he admitted that he was afraid that if he went updated advanced directives after talking with
if she wasn't able to make and communicate to the ER with an AD the staff would assume their children.
her wishes, and hadn't documented her choices that he did not want life-sustaining treatment.
Continued on page 18
in an AD, her son could have made decisions His AD took the form of a letter to his care
which were opposed to her own preferences. providers stating clearly that his life was worth
Central PA Medicine Spring 2018 17
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Table of Contents for the Digital Edition of Central PA Medicine Spring 2018
