By BRIAN AND KATHY DERRY
As summer winds down, it’s time to look again at that to do list, especially an item that most of us have put off for years, doing our Advance Care Plan. Fortunately there’s a way to face that task with others, making it easier.
Our “Kitchen Table Conversations About Advance Care Planning” workshop poses the questions that need to be addressed in a facilitated setting which encourages sharing. With stories, role playing and a panel of health care professionals who help people at the end of life, one participant described the workshop as “most impactful and educational for me.”
Our aim is to prepare participants for the most important part of advance care planning, the conversation with loved ones. As one person said, “My husband and I have differing wishes regarding end of life care, so the exercises were pretty revealing.” It’s easy to see the benefit of understanding those differences before a crisis develops, and before dementia sets in. Another participant who experienced the long journey of dementia with his wife said, “Once mid- to late-stage dementia develops, the individual will no longer be competent to make any decisions. It is essential to clearly identify your decision makers in both health care and financial matters.”
In the workshop we spend time looking at whom you might choose as your advocate or health care power of attorney. What are they expected to do? Who would be best able to ask the tough questions, such as will the person recover and what is the expected quality of life? Your advocate should have a good understanding of what you would say
Medicine has made significant progress in developing tools that lengthen life. Diseases that have been considered terminal can now be managed as chronic illnesses, like diabetes and heart disease. This has resulted in a movement toward shared decision making, with the doctor providing realistic side effects and outcomes, and the patient sharing his or her personal values and goals. Together they decide what treatment is appropriate for the individual.
One tool that we all have become familiar with through medical TV shows is CPR. In a typical TV depiction, the actor/patient survives. In reality, between eight and 18 percent of patients who’ve had CPR actually leave the hospital alive, and many sustain physical trauma like broken ribs. Whether a person survives depends on the age and health of the patient.
In our workshop we introduce people to the POLST, the Provider Orders for Life Sustaining Treatment, a document prepared by your health care provider that says whether you want such a procedure performed on you. Especially anyone who is frail or has a terminal diagnosis should consider having a conversation with their doctor about a POLST. With the POLST form posted on your refrigerator, emergency services will not use CPR or other procedures that you have declined.
Shared medical decision making is taken to another level with a new and growing specialty, pal-liative care. The palliative care specialist can be involved at any stage of life to focus on managing side effects of treatment and improving quality of life. This can be particularly helpful as chronic illnesses become more burdensome. Palliative care, sometimes called comfort care, focuses on dignity and quality of the remaining life, and requires ongoing management and conversation.
Hospice is also an important consideration when planning for life’s end. Hospice uses a team of doctors, nurses, social workers, aides, clergy and trained volunteers to augment the care you receive at home. The focus is on comfort and assuring the highest quality of life for an individual nearing life’s end. Treatments and testing that cause discomfort are suspended. Surprisingly, research is showing that many patients who choose comfort care earlier in their illness actually live longer with a higher quality of life.
You’ll learn more at the workshop, and gain the confidence and skills to begin having those “kitchen table conversations” of your own with loved ones. Imagine the relief and peace of mind you’ll feel to share your wishes! We hope you’ll join us at upcoming workshops this fall – you can get details at kitchentableconversations.eventbrite.com or by calling Missoula Aging Services at 728-7682.
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