​​Social worker and patient review Power of Attorney.
Robin Forbes, UHN social worker and Advance Care Planning Champion, reviews a Power of Attorney Kit with Dwayne Dulling, a patient at Princess Margaret Cancer Centre. (Photo: UHN) 

“Planning is bringing the future into the present
so that you can do something about it now.” 
- Alan Lakein, Writer


It is hard to argue against the advantages of planning ahead when it comes to any aspect of life. And there is arguably no greater planning than laying out your wishes for your health in the event you are unable or incapable of communicating your choices.  

This process is known as Advance Care Planning (ACP).  

At UHN, ACP is an important tool for patients because it ensures they have identified a trusted person to carry out their wishes and documents their preferences for treatment and care.

 

At the core of ACP are two fundamental questions:

1.Who do you trust to act on your wishes and make healthcare decisions on your behalf if you are not capable? (As documented in a Power of Attorney for Personal Care)
 
2.What are the values and preferences that should guide future decisions about your care in the event you are not capable? (As documented in an advance directive) 

“The goal for UHN is to normalize those questions across the organization by identifying moments during a patient’s visit to ask for these documents,” says Kyle Anstey, a Senior Bioethicist at UHN.   

“For those patients who don’t have them, we can offer them resources that help them to discuss the issue with their loved ones and better prepare those persons if they ever need to make decisions on the patient’s behalf.”   

UHN provides Power of Attorney kits and “Speak Up” advance directive workbooks, which are also available at www.advancecareplanning.ca

ACP is being incorporated into clinical practices across UHN with the support of UHN bioethics and 38 inter-professional ACP “champions”.   

The champions represent a diverse range of professions, each of whom were nominated by their leaders and provided education for incorporating the UHN ACP tools and resources into their area’s practice. The ACP champions meet quarterly as a group to share best practices and to find ways to grow the conversation around the organization.  

“Death and dying scares people but that doesn’t mean we shouldn’t talk about it,” says Robin Forbes, social worker and ACP champion.  

“As an Advance Care Planning Champion I have been doing a lot of speaking to my colleagues and making sure they know all the educational resources available for staff and patients at UHN. 

In the absence of ACP, health-care teams have witnessed families and loved ones experience additional stress when they have to make decisions on behalf of the patient, unsure if they are doing what that person would have wanted.

“I see relief in people’s eyes when they know they have options and are able to contribute to their health-care decision making,” says Robin Forbes, Advance Care Planning Champion at UHN.

In order to normalize ACP, health-care providers will often ask patients about their wishes before a visit or admission where there is little chance that this information will be immediately acted on.  If a patient presents with a broken finger but is otherwise well, it is unlikely that ACP information will be acted on during that visit to UHN.

However, once power of attorney information and advance directives are documented in our electronic patient record it is accessible in any unforeseen circumstances.   

“There is so much loss of autonomy associated with illness that Advance Care Planning is a way to give control back to the individual – it lets us know what really matters to them, what their goals of care are, and who they want to make decisions for them in the event that they can no longer direct their care,” says Forbes.

“I see relief in people’s eyes when they know they have options and are able to contribute to their health-care decision making.” 

ACP is sometimes talked about as preparing for the end of life.   

While many people have strong views about what they want and don’t want in those situations, people may be unable to speak for themselves in a range of circumstances where they are expected to fully recover.  

The point is to start conversations in advance of any of these situations and ensure that health-care professionals can partner with decision makers who are comfortable in speaking on behalf of the patient and confident they can represent wishes and values applicable to the situation. 

“At UHN the patient is placed at the centre of their care,” says Anstey.  

“ACP helps ensure the patient stays there when they can’t speak for themselves as we partner with and support persons making decisions on their behalf.” 

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