Friday, July 28, 2017

Jump-Starting Hard Conversations As The End Nears/ The End is Nigh

End of life decisions are usually neglected. Studies reveal few have an Advanced Directive prepared. 

Whenever one is admitted to hospital a standard question on admission forms is "Do you have an advanced directive?  Even if you ask for a form, denial sets in and the form is firmly tucked away in a pocket or purse.....to be discovered weeks later, and then promptly put in the round file.

Why do we do this ?  I am guilty of the same.  Death is a frightening event for almost all. Even physicians when it comes to themselves,  a wife or a child we freeze.  Physicians really never become comfortable emotionally with death. We file away the emotional reaction somewhere where we hide our fear, anxiety,  and grief.

After a tragic accident emotions run high and as death approaches we are paralyzed by events.

Most Americans avoid end-of-life decisions, although some people may be more likely to make them if a doctor or social worker starts the discussion. In California, the state attorney general’s office offers an end-of-life planning checklist on its website. In the past few years, other websites have encouraged those conversations, with their own suggestions on how to get started.

Rebecca Sudore, a geriatrician at the University of California-San Francisco, created prepareforyourcare.org, which provides step-by-step instructions and video stories to help people navigate the care they want at the end of their lives. She built the site in 2013 for families unsure how to broach sensitive questions. In a study published in JAMA Internal Medicine in May, she and other researchers found that the website — combined with the use of an “advance directive” form — prompted participants to plan ahead.
The study performed at a Veteran's Administration facility revealed many important points. 
Easy-to-use, patient-facing ACP tools, without clinician- and/or system-level interventions, can increase planning documentation 25% to 35%. Combining the PREPARE website with an easy-to-read AD resulted in higher planning documentation than the AD alone, suggesting that PREPARE may increase planning documentation with minimal health care system resources.The website is free, and Sudore makes no money from it.  It can be filled out at home from the website, Prepare for your Care
The site guides patients in drafting a “summary of wishes” to help families and other caregivers decide whether their loved ones should undergo life-sustaining medical interventions such as feeding tubes and ventilators.



Jump-Starting Hard Conversations As The End Nears | California Healthline
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