Make Your Wishes Known: Advance Care Planning

Content derived from DocTalk with Priyanka Choudhury, MHA

0:25 | What’s the difference between an advance care plan (ACP), a living will, an advance directive and a healthcare directive?
“Advance Care Plan” is an umbrella term that describes the process of communication and planning for your future healthcare decisions. For instance, if you were to suddenly become ill or injured and be unable to speak for yourself, it would be helpful to have an Advance Care Plan. Underneath the umbrella of advance care planning, there are different pieces:

• Advance Directives: These legal documents allow you to outline your healthcare wishes. There are two different documents that are considered Advance Directives:
  
  
  • Durable Power of Attorney (DPOA): In this document, you name the person you trust most to make decisions for you if you are ever unable to speak for yourself. This document is recommended for anyone over the age of 18.
    
  • Health Care Directive: In this document, also known as a Living Will, you outline your healthcare wishes for hypothetical situations. For instance, if you were in a permanent state of unconsciousness, would you want to continue care?
    
• Conversations: Conversations with those closest to us are another important piece of the advance care planning umbrella. In addition to filling out paperwork, it’s important to talk about your goals and values with those closest to you so they are aware of your wishes.
  

2:54 | What is a POLST?
POLST stands for Physician Order for Life-Sustaining Treatment, and it is also under the advance care planning umbrella. To better understand the purpose of this document, I like to compare it to the Health Care Directive.

As we know, the healthcare directive outlines your wishes for hypothetical future situations. In contrast, the POLST is a medical order, signed by a physician, that outlines your wishes for your current state of care. This means that POLST is most appropriate for patients who are seriously ill or medically frail and may be in the last few years of their life. If you have any questions about whether a POLST is a necessary document for you, the best person to ask is your primary care provider.

4:19 | Why do I need an Advance Care Plan?
It is never too early to be prepared! You never know when you could suddenly become ill or get into an accident, so these documents are important for anyone over the age of 18. The three main reasons to have an Advance Care Plan are:

1. It is a way for you, no matter your age, to make your healthcare wishes known.
   
2. It is a great way for your healthcare team to honor your health-care wishes.
   
3. It is a gift we get to give those closest to us because it gives them piece of mind knowing they are making the right decisions for us.
   

5:22 | How do I get started?
Advance care planning is a process, so we don’t expect everyone to complete everything in one sitting. The most important thing to remember is to take it one step at a time. The best way to start is to sit with yourself and reflect on your goals and values to decide what your wishes would be. From there, you would begin completing the necessary documents and then begin having those conversations with those closest to you.

6:07 | Do you need an attorney to fill out these documents?
Each of these documents do have legal requirements, but they do not require an attorney. Each of the Advance Directive documents need to be witnessed by two people or notarized by a notary. If you choose to have the documents witnessed by two people, those people do need to fit certain requirements as well, which are outlined on the document itself. Most people find it easiest to find a notary, and at Valley Medical Center, we have notaries in each of our primary care clinics. This means that if you are a patient at Valley, the next time you come in for your annual wellness visit, you can get those documents notarized.

7:00 | What do I do with the documents once they’re done?
Once they’re complete, most people think they should put their documents in a safe to keep them protected, but they are most valuable when they’re easily accessible. We recommend you make copies of the documents and share them with those closest to you, including the person you named as your DPOA, as well as with your healthcare team.
If you are familiar with MyChart, you can also upload your documents into your MyChart account so that it remains in your healthcare record and is always accessible to your healthcare team.

7:51 | How do you start a difficult ACP conversation with those closest to you?
It is very normal to feel uncomfortable having these conversations. Some tactics include:

1. Find something in the news. For instance, in this pandemic, there is no shortage of situations where people are becoming seriously ill. You can use one of these examples as a bridge to say, “I’d like to talk to you about if something like that ever happens to me and let you know what my wishes would be.”
   
   
2. Blame your doctor. This may sound silly, but in moments like this, we don’t mind taking the heat. You can say something like, “My primary care provider has been nagging me to do this, so I’d like to start the process. Would you mind sitting down with me for a few minutes so we can talk about it?”
   
   
3. Frame the talk around what matters to you. It is important to remember that conversations don’t have to be about end of life, death and dying. Instead, frame the conversation around what matters most to you, what quality of life looks like for you, and how those closest to you can support those things. The point of these conversations is to help inform those closest to you about the decisions they may need to make for you and how those decisions could impact your quality of life.

To learn more, visit valleymed.org/advancecareplanning