Having the talk

Apr 17, 2019 – McMaster University –

The Bottom Line

  •  Advance care planning involves discussions between patients, caregivers/family, and healthcare providers about end-of-life care decisions.
  •     In patients, advance care planning can increase documentation of end-of-life care preferences and the chance that the care provided matches their wishes.
  •  In caregivers and family members, advance care planning may lower stress, anxiety, and depression after loved ones have passed, and increase satisfaction in the care provided.

Few of us are eager to think about our final days, and we all hope to make our own healthcare decisions until the end. But, for many of us, there will come a point when we will be unable to do so (1;2).

Fortunately, Canadians are becoming more and more interested in expressing their wishes about the healthcare they would like to receive at the end of their life (3). One way to make these desires known and ensure that they are honoured is through advance care planning. This form of planning involves discussions between you (the patient), your family, and your healthcare providers around understanding your end-of-life wishes, and planning for future healthcare decisions in the event you are unable to communicate or make these decisions on your own (1;4). It provides clarity, and takes care of the overlap between health care, ethical values, and legal rights (3).

In a previous blog, Dr. Michelle Howard from McMaster University explained that she encourages all older adults to have ‘the talk’—sooner rather than later.

So, say you take that advice and engage in advance care planning, what does this mean for you and your loved ones?

What the research tells us;

One systematic review found that advance care planning may be beneficial for both patients and their families. Here, advance care planning included strategies such as information about advance care planning, communication between patients, family members, and healthcare professionals within home, hospice, nursing home, hospital or community settings, or even education for healthcare providers.

This research showed that advance care planning can increase documentation around end-of-life care preferences (for instance through durable powers of attorney or living wills), as well as the chances that the care provided aligns with the patient’s end-of-life wishes. Improved patient knowledge about living wills and life-sustaining treatments was also seen in some studies. Additionally, there was some evidence to suggest that implementing advance care planning strategies in nursing homes and long-term care may lead to reductions in avoidable and distressing hospitalizations in frail older adults.

The review wasn’t done yet…the good news kept on coming!

For caregivers and decision-makers, it was demonstrated that advance care planning strategies may reduce the stress, anxiety, and depression that they often experience when their loved one passes. What’s more, these strategies may also leave caregivers more satisfied with the care that was provided. While these findings are promising, the review also highlighted the need for better-conducted research, which uses appropriate study designs and looks at a wide-range of outcomes and settings, in order to draw more definitive conclusions on the effects of advance care planning (1).

So, there it is…end-of-life care is difficult to discuss. But, despite how hard ‘the talk’ is, advance care planning may be an important piece of the health care puzzle, which can benefit both you and your caregivers by providing clarity around sensitive care decisions.

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