August, 2002
Introduction
Primary Care Physicians are the link to medical
care for their patients. As such, they are the
ones who institute screening for diabetes, cholesterol,
cancer, smoking, etc. Equally important as other
screening tools is the introduction of advance
care planning for patients at the time of annual
exams. At that time, patients are prepared to
look at all aspects of their lives and it is
perfectly appropriate for them to explore what
they would want done medically if they were
no longer able to make decisions for themselves.
They need not complete the advance care directive
at that time, but the health care practitioner
can introduce the topic, literature can be given,
and an appointment to talk with someone knowledgeable
about advance care planning can be made.
Ideal Advance Care Planning
Successful community programs for advance care
planning have utilized a variety of approaches.
- It is helpful to have information in the
doctors' waiting rooms.
- Studies have shown that people are more
likely to complete advance care directives
if they are asked about them at their doctors'
offices. As part of the intake, nurses might
ask about Advance Care Planning (ACP) in the
same way that many of them now ask about smoking.
Doctors have made Advance Care Planning part
of annual physical exams.
- In larger clinics, one person has been designated
as the counselor for ACP. They have a special
interest and may have been trained by the
local hospice professionals in the details.
Patients who are interested in contemplating
these issues will make an appointment with
this person.
- The presence of an Advance Care Directive
(ACD) and a durable medical power of attorney
can be placed on the front of the chart along
with the problem list.
- Lawyers may include ACP in estate planning.
- Communities may arrange ACP days where doctors,
social workers, and lawyers take part in a
panel and there is an opportunity to complete
one's ACD after the panel discussion when
volunteer lawyers and doctors are available
to answer questions.
- Communities have had screenings of "On
Our Own Terms," the Bill Moyers' special
that looked at end-of-life issues. This four-part
series has fostered discussions that have
been facilitated by medical and/or social
work personnel knowledgeable about end-of-life
issues. The book and movie, Tuesdays with
Morrie and the play Wit have also
been used as springboards for community discussions.
- Hospitals have kept ACDs in a file so that
community members have access to their files
wherever they are in the world when they are
needed.
- Some hospitals keep the ACD and the durable
power of attorney for health care in a special
colored sleeve so that these items can be
easily located for every patient.
- Some churches have sponsored seminars and
discussions for introduction of ACDs to their
parishioners.
- There is no one way that is perfect for
every community, but we can learn from each
other. Multiple approaches in each community
are most effective.
How to Get Started
- Ask every patient at the time of their annual
exam if they have completed an ACD and a durable
power of attorney for health care.
- Keep appropriate forms in your office. These
can be printed from the Internet or, perhaps,
obtained from your local hospice. The exact
forms do differ from state to state.
- Add a line to your problem list to indicate
the ACP status of the patient.
- Contact your local hospice to see what is
already going on in your community. Give them
a copy of this handout to suggest other ideas.
- Consider training one interested person
from your clinic to be your local expert.
- Complete your own ACD and durable medical
power of attorney and ask your family members
to do so as well.
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