Advance Care Planning Fact Sheet by mlACicG


									                  Advance Care Planning Fact Sheet

What is Advance Care Planning?
Advance care planning is a process of reflection and communication, a time for you
to reflect on your values and wishes, and to let others know your future health and
personal care preferences in the event that you become incapable of consenting to or
refusing treatment or other care.

Advance care planning means having discussions with family and friends, especially
your Substitute Decision Maker – the person who will speak for you when you
cannot. It could also include writing down your wishes, and may even involve talking
with healthcare providers and financial and legal professionals.

Relevant research:

   In a recent national survey, more than 80% of respondents were concerned that
    the quality of health care in Canada will decline as a result of increased strain on
    the health care system as our population gets older.1

   In Canada, seniors 80+ represent the second fastest growing age group – one in
    five of these seniors will die in hospital, even though a number of them would
    prefer to die at home or in a palliative care setting.

   A March 2012 Ipsos-Reid national poll found that 86% of Canadians have not
    heard of advance care planning, and than less than half have had a discussion
    with a family member or friend about healthcare treatments if they were ill and
    unable to communicate. Only 9% had ever spoken to a healthcare provider about
    their wishes for care. Another study is currently underway across Canada to
    examine advance care planning from the perspective of health care providers.

   Research indicates that patients who have end-of-life conversations with their
    doctors and family members are much more likely to be satisfied with their care,
    will require fewer aggressive interventions at the end of life, place less of a strain
    on caregivers and are more likely to take advantage of hospice resources or die
    at home. 2,3

  Ipsos Reid. 10th Annual Report Card on National Health Care., last accessed
Aug. 28, 2010
  Wright, AA, et al. Associations between end-of-life discussion, health care expenditures,
JAMA, 2008, 300 (14) 1665-1673
   A 2008 study found that the absence of advance care planning, in all its forms,
    was associated with worse patients’ ratings of quality of life in the terminal phase
    of the illness and worse ratings of satisfaction by the family during the terminal
    illness or in the months that follow death.2

   A 2010 Canadian study of hospitalized, elderly patients identified that there is a
    huge unmet need, that providing more support for end-of-life conversations and
    advance care planning will have a large positive impact on improving end-of-life
    care in Canada.4

   A new study by Queen’s University researcher Dr. Daren Heyland will evaluate
    whether advance care planning, a process of documenting and communicating
    end of life care wishes, can reduce health care costs for Canadians, while
    improving the quality of that care. The ACCEPT study (Advance Care Planning
    Evaluation in Hospitalized Elderly Patients) will be conducted at ten hospitals
    across western Canada over a three-year time period to help researchers
    governments and health professionals better understand the benefits of and
    barriers to advance care planning.

About Advance Care Planning

Who should make an advance care plan?
Every adult should make a plan. You can’t predict how or when you will die – so
having a plan ensures that others know your wishes and that your voice will be
heard if you cannot speak for yourself.

It’s also important to name and talk to your substitute decision maker – the person
who will speak for you if you cannot speak for yourself – about your wishes for care.
If you have a written plan, your substitute decision maker should have a copy.

When is an advance care plan used?
You plan is only used if you are unable to make your own health care decisions (e.g.
you are in a coma or your illness has impaired your ability to make decisions). Your
substitute decision maker can use it to guide your care and to express wishes on
your behalf.

Can an advance care plan be changed?
Our lives - and the people around us – change over time. You’ll want to review your
advance care plan regularly and revise it to be sure it reflects your wishes, and to
talk to your substitute decision maker about these changes. Remember, your
substitute decision maker will be consulted and your plan used only if you cannot
speak for yourself.

  Heyland, DK, Allan DE, Rocker G, Dodek P, Pichoa D, Gafni A. Discussing prognosis with
patients and their families near the end of life. Impact on satisfaction with end of life care.
Open Medicine 2009, 3(20: 71-80
  Heyland DK, Cook DJ, Rocker GM, Dodek PM, Kutsogiannis DJ, Skrobik Y, Jiang X, Day AG,
Cohen SR. Defining priorities for improving end-of-life care in Canada. Can Med Assoc J
Is an advance care plan the same as a Living Will?
A living will is a form of advance care planning – but it is very important to have a
conversation with those who will make decisions about your care – so they know
your wishes. You should also review your advance care plan regularly to be sure that
it still reflects your feelings, beliefs and values about end of life care. Each province
and territory has specific legislation to support the documentation of advance care

Advance care planning activity

          The Canadian Hospice Palliative Care Association (CHPCA), in collaboration
           with the National Advance Care Planning Task Group, has launched a
           campaign to help Canadians begin a conversation about their wishes for end
           of life care. The “Speak Up: Start the conversation about end-of-life care”
           campaign includes a website ( that provides a
           number of valuable resources for Canadians, policy-makers, health care
           professionals and community organizations to discuss these issues in greater

          April 16th has been designated National Advance Care Planning Day in
           Canada, a date shared with the U.S. National Health Care Decisions Day.
           Organizations in both countries are sharing resources and ideas for raising
           awareness of advance care planning.

          The main purpose of the Speak Up: Start the conversation about end-of-life
           care campaign and National Advance Care Planning Day is to raise awareness
           among Canadians about advance care planning and to provide them with the
           resources they need to have conversations about their preferences for care.
           We are also working to build partnerships across Canada with governments,
           professional groups, NGOs and communities to facilitate these conversations.

          The Quality End-of-Life Care Coalition of Canada states that one of the key
           challenges over the next ten years will be persuading Canadians that end-of-
           life care planning is important for everyone, not just those diagnosed with a
           life-limiting illness, such as cancer .

          In its November 2011 Report entitled “End of Life Decision Making”, the Royal
           Society of Canada Expert Panel notes that “Advance care planning still
           remains a topic not sufficiently discussed by individuals, their families and
           their health care providers, with the vast majority of Canadians having
           neither proxy nor instruction directives. The absence of explicit dialogue
           between patients and health care providers is of concern to the Panel. The
           Panel recommends more research into how to facilitate the completion of
           advance care plans, better education, more resources to encourage and
           facilitate discussions and more mechanisms to ensure that the results of
           these discussions are clear in all health care settings.”6

          The Parliamentary Committee on Hospice and Palliative Care released a report
           on November 17, 2011 that recommends that the federal government either

  Quality End-of-Life Care Coalition of Canada. Blueprint for Action 2010 to 2020. Ottawa, ON. January 2010,
    Royal Society of Canada Expert Panel on End of Life Decision Making, Report, November 2011, p.94-95
        through Health Canada or the recommended Palliative Care Secretariat fund a
        national public awareness campaign on palliative and end-of- life care. An
        aspect of this campaign should be to encourage Canadians both to talk about
        end-of-life care, and go through the process of advance care planning. 7

The Canadian Hospice Palliative Care Association (CHPCA) is a national, bilingual
charitable non-profit association with membership comprised of individuals and
hospice palliative care programs and services from every province and territory. The
CHPCA is a member of the National Advance Care Planning Task Group, comprised of
representatives from a number of organizations and professions across Canada. The
Task Group has collaborated to develop Advance Care Planning in Canada: A National
Framework and Implementation and the Speak Up: Start the conversation about
end-of-life care campaign.

  Parliamentary Committee on Palliative and Compassionate Care, “Not To Be Forgotten: Care of
Vulnerable Canadians, November 17, 2011, p. 37

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