Recommendations for Advance Care Planning

00:00 So, despite all those limitations, despite the debate that goes on about our advanced directives, the documents helpful, I still think there is a role for advanced care planning.

00:12 I think the most important step, as I said is going to be encouraged the patient to appoint a health care proxy.

00:18 So choosing a person that the patient trust, so they can know how decisions should be made for them.

00:24 The idea here is to say, who will speak for you? So the next recommendation for advanced care planning is to encourage the discussion between the patient and the healthcare proxy.

00:34 It's not enough just for the patient to name who's going to speak for them.

00:38 But they need to have a conversation with that person, so that there can be clarity about the values and preferences of the patient over time.

00:46 So as the patient's health changes over time, where their disease progresses, that they're having ongoing conversations with that health care proxy, so they know, you know, what does this patient want? If they have to face these future treatment decisions, and the proxy is now in the place of making those decisions.

01:05 So, the idea here is, who will you speak to? Who is going to be your proxy to help make these decisions on your behalf? And then lastly, there needs to be improved communication between the clinicians and the healthcare proxy.

01:20 Obviously, the clinicians are going to be talking to the patient when they have capacity, and can be involved in the informed consent process, and have these goals of care discussions.

01:29 But there also needs to be an opportunity to make sure that the clinicians are communicating with the health care proxy.

01:35 So the idea here is to implement decisions that are based on a mutual understanding of what is important to the patient.

01:41 The clinicians have talked to the patient in the past.

01:44 The health care proxy has talked to them, they come to a mutual understanding of what is important to the patient.

01:49 So, in this, it's all about who will speak about your values and preferences? So, you want to say, who will speak for you? Who will you speak to? And who will speak about you and your values and your preferences? So, that's the nature of advanced care planning, what we're hoping to achieve, thinking about future health care decisions, and involving the patient in that process.