Advanced care planning Flashcards
motto of pediatricians when it comes to palliative care
“we should add more life to child’s years rather than simply years to a child’s life”
Advanced care planning components
- treatment goals (long-term and short term) 2. resus specifications
when is palliative care appropriate?
not only when child is actually dying at any point following diagnosis of a life-limiting condition
Can palliative care be simultaneous with curative treatments
yes…this is a dimmer switch philosophy rather than on-off switch beneficial when implemented early
principles of palliative care
reduce suffering and focus on quality of life and quality of dying Not limited to end of life care Continues as bereavement support when patient dies
health care providers should be aware of their bias of ____
feeling failure when a child has terminal illnes, which may contribute to reluctance to initiate advance care planning discussions
rather than “giving up” associated with involving palliative care
should focus on “giving in” to reality of the situation that child has a terminal illness
when providing advanced care directives planning
be clear (not all or none) decide on individual interventions that are feasible for the child may also be helpful to involve spiritual leader
In regards to legal advanced directives in pediatrics, are mature minors able to create their own advanced directives?
No Most jurisdictions in Canada do not have legislation granting legal validity to advance directives made by mature minors The legal age for advance directives is 16 years in Saskatchewan, Ontario, New Brunswick, Prince Edward Island and Newfoundland
what is the issue with HCPs drafting advance directives with input of parents?
variable acceptance by third parties because of the lack of legal status (they or not drafted by the patient but by the SDM) may not always be respected (by schools or EMS)
recommendations regarding advance care planning
Advance care planning is part of the standard of care for paediatricians and other health care practitioners involved in the care of paediatric patients with chronic life-threatening conditions. It is our responsibility to initiate these discussions, rather than wait for patients and family members to ask. These discussions should occur early and regularly throughout the course of treatment, ideally before crises arise, and as the goals of care are clarified or change over time. Decisions should be reviewed and revised on a regular basis as the medical condition and knowledge of treatment and prognosis evolve. Clarification of wishes regarding emergency and life-sustaining therapies including CPR should be obtained and documented so that these advance directives can be communicated with others, such as home care workers and schools. Palliative care is a potential adjunct to the health care of all children with severe chronic conditions with shortened life expectancy. Palliative care options should be integrated into discussions of treatment goals where appropriate. Paediatric palliative care professionals should be involved early in discussions of treatment goals. Paediatric health care professionals should advocate for uniform legislation across Canada on advance directives for minors.
List 5 components of the advance care planning checklist
