End of life care

Question 1

What is advanced care planning

Answer 1

process for identifying and communicating an individuals values and preferences regarding future health care

Question 2

Why is ACP good

Answer 2

allows pt to prepare for decisions regarding health care and clarify values and goals of care for when they are no longer able to make decisions

Question 3

Why is ACP important

Answer 3

it builds trust
reduces uncertainty
helps avoid confusion and conflict
permits peace of mind

Question 4

What are advanced directives

Answer 4

Living will
Medical or Health care power of attorney
Do not resuscitate

Question 5

What is a living will (advance directive)

Answer 5

Written statement that expresses your wishes about medical Tx that would delay death from a terminal condition

• Persistent vegetative state, or coma
• Basically speaks for you if you can’t communicate

Question 6

What is a Medical POA

Answer 6

Document that lets you choose another person (“agent”) to make your health care decisions if you no longer can
-Can include limits

Question 7

What is a physician order for life sustaining treatment (POLST)

Answer 7

Medical orders to be honored by health care workers during a crisis (essentially a DNR) BUT-
not available in all states; there are program requirements’ must have a valid clinician (MD, PA, NP)

Question 8

Who makes these decisions

Answer 8

The pt (he can invite family/friends) 
If pt cant, check chart for Advanced Directive document (living will, MPOA, DPOA)

Question 9

What if the patient does not have an AD

Answer 9

clinicians can identify and select a surrogate medical decision maker

Question 10

Priority of surrogates in AZ are

Answer 10

Spouse (unless legally separated)
Adult child (if many kids, get consent of majority)
Pt parent
Domestic partner
Sibling of pt
Close friend
Lastly, patients physician (must get approval from institutions ethics committee)

Question 11

Who can NOT be a surrogate

Answer 11

the treating health care provider
employee of the treating provider (unless related to pt)
owner, operator, or administrator (of their employee) of pt/s current health care facility

Question 12

What is the “conversation project”

Answer 12

started in 2010 to help people talk about their wishes for end of life care, or help a provider talk to a patient
*Does not need to be notarized

Question 13

What is “five wishes” composed of

Answer 13

1 (legal doc): the person I want to make care decisions for me
2 (legal doc): the kind of medical treatment I want or dont want
3: how comfortable I want to be
4: How I want people to treat me
5: What I want my loved ones to know

Question 14

Where do you keep your five wishes ACD

Answer 14

somewhere in your home, safe, but not in a safety deposit box that is very hard to reach

Question 15

What are the two power of attorneys

Answer 15

general POA: act in charge of finances, NOT medical aspects

must be Medical POA to make those decisions

Question 16

Can you act from a living will?

Answer 16

No, you must act form a DNR (ex POLST, or a “code status”)
So even if someone’s will says they dont want to be placed on a ventilator but they don’t have a DNR, you still put them on a ventilator

Question 17

What does a POLST include

Answer 17

do you want to be kept on meds? Abx? nutrition? ventilator? etc.

Question 18

How often do you review POLST

Answer 18

Yearly

Question 19

Do you have to have a lawyer to complete the AZ life care planning forms

Answer 19

No, but you DO need a notary!

Question 20

What does the “life care planning packet” contain

Answer 20

registration agreement 
durable medical POA 
durable mental health POA
living will 
letter to my representative 
prehospital medical care directive (DNR)

Question 21

Is an autopsy required?

Answer 21

Not unless a medical examiner, district attorney, or district court judge requires it

Question 22

What should you do if you dont know someone’s code status

Answer 22

CODE THEM!

Start basic life support while someone is looking for a patient’s code status and ACD

Question 23

What is a clinician’s role in ACP

Answer 23

We emphasize that ACP is a process, not a document!

Partner with your patient and review if the condition changes

Question 24

Point to remember

Answer 24

Just because we CAN do things in medicine, doesnt mean we SHOULD

Question 25

Clinicians should encourage patients to

Answer 25

share their personal goals in the context of their life limiting illness

Question 26

Potential goals of care are

Answer 26

Cure a disease 
prolong a disease 
maintain or improve Fxn/ QoL
relieve burdens, support loved ones 
relieve suffering 
accomplish personal goals

Question 27

Do goals always stay the same

Answer 27

No, you can have changing goals, multiple goals, and some goals that you have to sacrifice to meet other more important goals

Question 28

What are “primary goals”

Answer 28

Curative: restore health by treating the underlying condition
Palliative: promote comfort by relieving pain
Combination: do both! but when they conflict, you may need to choose one over the other

Question 29

As a clinician, these are our keys for success

Answer 29

create the right setting
assess patients readiness to have the discussion
balance truth and hope
have a patient talk about their concerns