Dr. Arpit Arora, Part 2

RUSK Insights on Rehabilitation Medicine

Part 2

Advance care planning involves talking now about the future and the setting where someone has deteriorating health and is not able to converse with clinicians about patients’ wishes, preferences, fears, expectations of what is going on, and their hopes. At this juncture, there can be a discussion about a patient’s quality of life and what he or she would like it to be. Sometimes, patient preferences can be put into advance directives (e.g., a living will or a medical power-of-attorney). Some barriers to advance care planning were described. Examples of patient barriers are procrastination, apathy, and fear of burdening the family. Some provider barriers are a lack of desire in talking about a negative future outcome and not wanting to burden patients and families by discussing this topic. Two other big considerations are time constraints on the part of providers and a general lack of knowledge about advance directives. It is important to be able to offer some sort of direction to families regarding possible health care outcomes even when there is a lot of uncertainty. End-of-life care can make some individuals nervous, which is understandable. Withholding or withdrawing interventions that are not in line with patient goals is OK. We do not want to cause any harm or do inappropriate things. As long as we are eliciting what is important to families and doing what meets their goals, generally speaking, we are doing the right thing.