scholarly journals The Advance Care Compass– A New Mechanics for Digitally Transforming Advance Directives

2021 ◽  
Vol 3 ◽  
Author(s):  
Nikola Biller-Andorno ◽  
Armin Biller
Keyword(s):  
Intensive Care ◽  
Advance Directives ◽  
Treatment Preferences ◽  
Care Planning ◽  
Legal Documents ◽  
The Past ◽  
Future State ◽  
Limited Success ◽  
Advance Care ◽  
The Individual

Advance directives allow people to declare their treatment preferences for a potential future state of incompetency. Covid-19, with its high numbers of quickly deteriorating patients requiring intensive care, has acutely demonstrated how helpful it would be for clinicians to have reliable, readily available, up-to-date information at hand to be able to act in accordance with what the individual patient would have wanted. Yet for the past few decades advance directives have fallen short of their potential, for various reasons. At worst, advance directives are perceived as unwieldy legal documents that put excessive demands on patients without providing useful guidance for better care. Recent efforts such as advance care planning have tried to remedy some of these shortcomings but have so far met with limited success. We suggest a new concept—the Advance Care Compass—that harnesses the potential of digitalization in healthcare to overcome many of difficulties encountered so far.

scholarly journals Advance care planning and advance directives: an overview of the main critical issues

2021 ◽  
Author(s):  
Cristina Sedini ◽  
Martina Biotto ◽  
Lorenza M. Crespi Bel’skij ◽  
Roberto Ercole Moroni Grandini ◽  
Matteo Cesari
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Legal Documents ◽  
The Past ◽  
Critical Issues ◽  
Future Care ◽  
Advance Care

AbstractAdvance care planning (ACP) is a process that guarantees the respect of the patient’s values and priorities about his/her future care at the end of life. It consists of multiple conversations with the health professional that may lead to the completion of Advance Directives (AD), a set of legal documents helpful to clinicians and family members for making critical decisions on behalf of the patient, whereas he/she might become incapable. Over the past years, ACP has become particularly relevant for the growth of chronic diseases, the increase in life expectancy, and the growing attention paid to the patient’s decisional autonomy. Several nations have introduced specific regulations of ACP and AD. However, their diffusion is accompanied by unforeseen limitations and issues, burdening their complete and systematic adoption. The present article describes several controversial aspects of ACP and some of the most significant challenges in end-of-life care.

Documentation of Advance Directives and Code Status in Electronic Medical Records to Honor Goals of Care

2019 ◽  
Vol 35 (4) ◽  
pp. 217-220 ◽  
Author(s):  
Meaghann S. Weaver ◽  
Betty Anderson ◽  
Anne Cole ◽  
Maureen E. Lyon
Keyword(s):  
Electronic Medical Records ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Medical Records ◽  
Current Approach ◽  
Treatment Preferences ◽  
Care Planning ◽  
Record System ◽  
Code Status ◽  
Advance Care

Advance care planning is a process that supports conversations about the values that matter most to patients and their family members. The documentation of advance directives and code status in a patient’s electronic health record (EHR) is a critical step to ensure treatment preferences are honored in the medical care received. The current approach to advanced care planning documentation in electronic medical records often remains disparate within and across EHR systems. Without a standardized format for documentation or centralized location for documentation, advance directives and even code status content are often difficult to access within electronic medical records. This case report launched our palliative care team into partnership with the Information Technology team for implementation of a centralized, standardized, longitudinal, functional documentation of advance care planning and code status in the electronic medical record system.

scholarly journals Advance care planning in Dutch primary care: a pre/post-implementation study

2021 ◽  
pp. bmjspcare-2020-002762
Author(s):  
Annicka van der Plas ◽  
Jolien Glaudemans ◽  
Bregje Onwuteaka-Philipsen
Keyword(s):  
Older People ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Evaluation Study ◽  
Routine Care ◽  
Treatment Preferences ◽  
Care Planning ◽  
Future Health ◽  
Advance Care ◽  
Clear Idea

BackgroundDespite known advantages of advance care planning (ACP) and a positive attitude towards ACP by older people living in the community and general practitioners (GPs), such conversations are not yet commonplace in GP practices.AimTo implement ACP as part of routine care in general practice and thereby increasing the number of ACP conversations and advance directives; to investigate characteristics of older people with and without an ACP conversation.Methods(1) A pre-evaluation and post-evaluation study using questionnaire data from people aged 75 years or older living in the community. (2) A prospective study using data provided by healthcare professionals (people they started an ACP conversation with).ResultsAfter implementation of ACP, significantly more people had spoken to their GP about hospitalisations, intensive care admission and treatment preferences in certain circumstances, compared with before. Advance directives were drawn up more often. People who had an ACP conversation were older, have had a cerebrovascular accident, had a clear idea about future health problems, had a preference to start ACP before they were ill, already had an ACP conversation at pre-measurement and indicated at pre-measurement that their GP knows their preferences.ConclusionResults in number of ACP conversations and advance drectives were modest but positive. ACP was implemented as routine care. GPs select people with whom they have a conversation. This can be an efficient use of time, but there is a risk that certain groups may be underserved (for example, patients with multimorbidity or patients with less health skills).

scholarly journals Adolescent and adult laryngotracheal stenosis: a review

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Gerhard Johan Klopper ◽  
Oladele Vincent Adeniyi ◽  
Kate Stephenson
Keyword(s):  
Intensive Care ◽  
Past Century ◽  
Main Body ◽  
Laryngotracheal Stenosis ◽  
Airway Protection ◽  
Interventional Pulmonology ◽  
The Past ◽  
Airway Emergency ◽  
The Individual ◽  
And Function

Abstract Background The larynx has multiple composite functions which include phonation, airway protection, and sensory control of respiration. Stenosis of the larynx and trachea were first recorded by O’Dwyer in 1885 and by Colles in 1886, respectively. Initially, the aetiology of laryngotracheal stenosis was predominantly infective. Currently, the leading cause is iatrogenic injury to the laryngotracheal complex secondary to prolonged ventilation in an intensive care unit. Main body Laryngotracheal stenosis is a complex and diverse disease. It poses a major challenge to the surgeon and can present as an airway emergency. Management typically demands the combined involvement of various disciplines including otorhinolaryngology, cardiothoracic surgery, anaesthesiology, interventional pulmonology, and radiology. Both the disease and its management can impact upon respiration, voice, and swallowing. The incidence of iatrogenic laryngotracheal stenosis has reflected the evolution of airway and intensive care whilst airway surgery has advanced concurrently over the past century. Correction of laryngotracheal stenosis requires expansion of the airway lumen; this is achieved by either endoscopic or open surgery. We review the relevant basic science, aetiopathogenesis, diagnosis, management, and treatment outcomes of LTS. Conclusion The choice of surgical procedure in the management of laryngotracheal stenosis is often dictated by the individual anatomy and function of the larynx and trachea, together with patient factors and available facilities. Regardless of how the surgeon chooses to approach these lesions, prevention of iatrogenic laryngotracheal damage remains of primary importance.

Decision-Making Toolkit

2021 ◽  
pp. 60-76
Author(s):  
Jeffrey D. Myers
Keyword(s):  
Decision Making ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Physician Assistant ◽  
Healthcare Providers ◽  
Terminally Ill ◽  
Decision Makers ◽  
Care Planning ◽  
Collaborative Partnership ◽  
Advance Care

Physician assistant (PA) training is rooted in treating the whole patient and developing a trusting and collaborative partnership with patients and their families. This foundation is critical in the advance care planning (ACP) process for patients who are seriously or terminally ill. Understanding the ACP process, the components and reasons behind them, and the tools for successful discussions and decision-making is a key skill set for all healthcare providers, including PAs. This chapter examines the components of ACP, including advance directives, the POLST paradigm, decision-makers, prognostication, documentation, and legacy planning. ACP is key in capturing what is most important to our patients in terms of their health, their life, and their goals related to both.

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