Last week\u2019s EBN Twitter chat \u201cEnd of Life Care; One Chance to Get it Right\u201d highlighted the important issue of the care of those who are dying.\u00a0 As nurses, we are all encouraged to individualize care and to \u2018start the conversation\u2019 with patients about their wishes, but where does this start?\u00a0 What does it entail?\u00a0\u00a0 I think we would all agree that the best time to initiate discussions early\u2026hopefully before palliation, hospitalization, or a catastrophic event that prevents a person from extending how they would like to die.\u00a0 In fact, I suggest that the conversation should start with people that the patient knows, and who know the patient well; in primary health care.<\/p>\n
The discussion about advance care planning is a process of reflection and communication.\u00a0 Patients and families may reflect on their values and wishes, and let others know their future health and personal care preferences in the event that they become unable to consent or refuse treatment (CHPCA, 2014). \u00a0Advance care planning is ongoing and may include the patient, his\/her family and substitute decision-maker as well as healthcare providers.\u00a0 Advance care planning may be informal, or formal.\u00a0 It may include development of an end-of-life plan of care with appropriate legal documentation.\u00a0 Although there are parts of Advance Care Planning that nurses may not be comfortable or competent to enact, entering into a discussion with a patient about their wishes is a vital first step (Sudore & Fried, 2010).<\/p>\n
Most people in the developed world die as a result of chronic diseases.\u00a0 These conditions are often diagnosed and monitored in primary healthcare settings well before end of life. Health care staff, including nurses and NPs working in primary health care, get to know their patients well. Because of this, they are in a unique position to initiate advance care planning discussions with them before they enter into the palliative stages.\u00a0\u00a0 In fact, patients and their families are often waiting for health care providers to initiate Advance Care Planning discussions (Davison & Simpson, 2006; Jackson et al., 2012).<\/p>\n
In clinic several months ago, I sent a patient for testing and he was diagnosed with a cancerous tumor.\u00a0 He has received treatment from the Cancer Treatment Centre in our city, but continues to come to the primary health care clinic for renewal of routine medications. He\u2019s brought his wife to his recent appointments.\u00a0 I took the time at the last appointment to ask him if he had thought about end of life care\u2026being sure to add that I wasn\u2019t expecting this imminently! He and his wife relieved to discuss their plans and he told me that he was grateful that I brought it up since he now felt more comfortable approaching the clinic for assistance in making his death a good one, when the time came. \u00a0With my assistance, the patient and his wife were connected to a social worker who helped them to complete legal documents, such as\u00a0 \u2018power of attorney\u2019 and a \u2018living will\u2019.<\/p>\n
By initiating advance care planning discussion with patients, the nurse may help to increase the patient\u2019s satisfaction and reduce stress, anxiety, and depression. Substitute decision makers also have reduced stress, particularly in knowing their loved one\u2019s wishes (Detering, Hancock, Reade, & Silvester, 2010).<\/p>\n
Nurses play an important role in the care of patients who are dying, at every stage.\u00a0 We shouldn\u2019t be hesitant to ensure our patients have had the opportunity to express their wishes and to help them formalize them in preparation for the life journey ahead.<\/p>\n
Canadian Hospice Palliative Care Association (2014).\u00a0 Speak Up. Advance Care Planning Retrieved from:\u00a0 http:\/\/advancecareplanning.ca\/<\/p>\n
Davison, S. N., & Simpson, C. (2006). Hope and advance care planning in patients with end stage renal disease: Qualitative interview study. British Medical Journal, 333, 886-889.<\/p>\n
Detering, K. M., Hancock, A. D., Reade, M. C., & Silvester, W. (2010). The impact of advance care planning on end of life care in elderly patients: Randomised controlled trial. British Medical Journal, 340(1345), 1-9.<\/p>\n
Jackson, J., White, P., Fiorini, J., Shay, J. T., Derderian, L., Ayotte, J., & Osgood Hall, R. (2012). Family perspectives on end-of-life care. Journal of Hospice & Palliative Nursing, 14(4), 303-311.<\/p>\n
Sudore, R. L., & Fried, T. R. (2010). Redefining the “planning” in advance care planning: Preparing for end-of-life decision making. Annals of Internal Medicine, 153(4), 256-262.<\/p>\n
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Last week\u2019s EBN Twitter chat \u201cEnd of Life Care; One Chance to Get it Right\u201d highlighted the important issue of the care of those who are dying.\u00a0 As nurses, we are all encouraged to individualize care and to \u2018start the conversation\u2019 with patients about their wishes, but where does this start?\u00a0 What does it entail?\u00a0\u00a0 […]<\/p>\n