class: center, middle, inverse, title-slide # BSOC/STS 2051 Discussion Section ## Week 6, Disc 5 ### Xuewen Yan ### 2021-10-01 --- # Housekeeping Check in now: [Attendance sheet](https://forms.gle/qB3gpvLef8frMmfZ7) Section slides: [https://rpubs.com/xwueyan](https://rpubs.com/xwueyan) Case analysis due: 10/7 --- # Discussion posts summary Should we encourage research and education on Advanced Care Planning (ACP)? The Morrison vs Tishelman debate - Goal concordant care vs ACP? - Process vs product? - Accidents and injuries? Covid 19? Should physicians play a role in initiating the discussions about ACP? How? - Sanders --- # AD: Advance Directives vs ACP? --- # AD: Advance Directives Legal documents (also verbal) delineating preferences: - Living wills: Specific care preferences at EoL - Health care POA (Designates Agent or Proxy): a legal document that lets you give someone legal authority to make important decisions about your medical care - Completed by an adult with decisional capacity - Implemented when lose ability to make decisions - Can be revoked orally or in writing at any time - Statues vary from state to state --- # AD: Advance Directives **Benefits of ADs** **Limitations of ADs** --- # AD: Advance Directives **Benefits of ADs** - Respects patient’s autonomy - Enhances likelihood of receiving care consistent with ones goals and wishes - Reduces decisional burden for family - Decreases moral distress for HCPs - Provides a framework for facilitating discussion with family and HCPs **Limitations of ADs** - Confusing, legal requirements - Often not “informed” - Can’t anticipate all future circumstances - Info not specific enough to be useful - Goals/preferences change over time - Difficulty predicting future prefs. - Forms not available when needed - Following AD may become impractical - May conflict with pt’s best interests - State variability - Issues of reciprocity --- # ADs are most trustworthy if: – Indicates specific Rxs (a doctor's prescription), in particular clinical situations – Informed (e.g. discussed with the HCP) – Directive repeated over time, in different situations to various individuals – Recently completed (closer in time to decision) – Does not clearly contradict the patient’s current best interests --- # Advance Care Planning - Ongoing iterative process – revisited over time - Starting focus: individual’s goals and values (vs. specific decisions) - Brings together patients, families (future surrogates), clinicians - Discussions can be embodied in written documents/orders (ADs) - Started at any time (esp. c/ dx of serious or life-limiting condition) - Revisited periodically - Discussions get more specific as health status warrants --- # Section Activity: The GoWish game [Self-experiment first](http://www.gowish.org/gowish/gowish.html) Technology free week!