Every patient’s choice for current and future healthcare should be respected and supported. We want to provide an environment where you can make fully informed, thoughtful decisions regarding your current and future care. We want to ensure every patient is able to:
- Access programs, tools and resources to make those decisions.
- Document those decisions.
- Have those decisions respected and supported by their healthcare team and family and friends.
What is Advance Care Planning?
Advance care planning is the process of learning about the choices you have in relation to your future medical care, and how you want to be treated if you are unable to speak for yourself.
These discussions can be very different, depending on your current health. The process includes:
- Learning about medical treatment options and the goals for those treatments.
- Taking time to explore thoughts and feelings about life-saving or life-sustaining treatments, which can include talking with your family and healthcare team.
- Choosing a healthcare advocate to represent your choices if you are unable to speak for yourself.
- Putting your wishes into writing.
Services We Offer
Our advance care planning professionals are available to assist you with all aspects of your advance care planning, answer your questions, and guide you through the process. We provide:
- Counseling services with your primary care physician who may know you best or an affiliated advanced practice provider such as a nurse practitioner or physician assistant, nurse, and social worker who guide you through the decision-making process and help you communicate your end-of-life wishes.
- Legally-binding documents – advance directives, medical power of attorney, and/or a do-not-resuscitate order.
- Choosing a healthcare advocate to act on your behalf regarding medical treatment in the event that you are unable to communicate.
- Understanding treatment options with palliative and hospice care.
Advance care planning is designed to outline your future medical choices. Understanding your medical treatment options will help clarify your wishes and values.
Factors to consider when choosing medical treatment options include:
- When to start treatment
- When to stop, or not start, treatment
- Establishing the goals of treatment
- How and when to use comfort measures
Medical Treatment Options
Medical treatment options are characterized as either lifesaving or life sustaining. These medical treatment options may include antibiotics, IV hydration and nutritional support, kidney or renal dialysis, cardiopulmonary resuscitation (CPR), and intubation/ventilation.
Your decision to accept or forego each of these treatment options must be considered in relation to your health, personal values, and wishes. While you may choose to forego treatment and “let nature take its course,” others may find it unacceptable to withhold treatment without understanding first that it is your wish.
Deciding What Medical Option is Right for You
Making decisions about future medical care requires much discussion and reflection and can be a very emotional process. Talking with your healthcare providers and your family can give you perspective and valuable information, but you need to make decisions that are right for you.
This is an ongoing process. What is right for you now may not be right six months or 10 years from now. Some questions to ask include:
- What experiences have you had with a loved one or close friend who faced decisions about a life-sustaining treatment and what did you learn from that?
- When would I want life-sustaining treatment and under what circumstances would I want it stopped?
- What do the terms, a good life, or living well, mean to me at this point in my life?
Once you have considered your options and decided upon your ideal end-of-life care, the next steps are to clarify your wishes by drafting medical directives.
Choosing your healthcare advocate is one of the most important decisions in the advance care planning process. Your healthcare advocate implements your medical power of attorney. This person is legally empowered to carry out your healthcare wishes and decisions when you are no longer able to do so. It’s vital that your healthcare advocate understand the quality of life that is important to you.
Your advocate may be a family member, close friend, or someone else you trust to make decisions in accordance with your wishes. You should have discussions with your healthcare advocate about your future medical choices, including specifics about when and what medical treatment options to have. Some questions to ask a potential advocate include:
- Do you understand my wishes, values, and treatment goals?
- Are you willing to follow my preferences even if others disagree?
- Can you uphold my wishes even if others challenge my decisions?
Your wishes may change as your situation changes, and you should have an ongoing dialogue with your healthcare advocate about your choices.
Palliative care includes the management of physical symptoms, as well as the psychological and spiritual challenges that come from living with a life-threatening disease.
Using Palliative Care
Our medical teams use the latest treatments coupled with evidence-based cancer research and technology to help you fight cancer. However, not all treatment therapies are successful for patients and palliative and hospice care may become appropriate options.
Palliative Care Options
Treatment options for palliative care consist of managing pain, nausea, breathing difficulties, and improving your overall comfort level. Your care team will work together with you to manage the physical treatments and identify resources to provide emotional and spiritual care.
While not always the case, palliative care is often administered to patients during chemotherapy treatment.
Choosing Hospice Care
If your physicians feel that hospice is appropriate for you, they will connect you to hospice care.
Hospice care is designed to maintain a quality of life and comfort level for patients nearing the end of life. A coordinated hospice team including physicians, nurses, social workers, clergy and volunteers care for patients and provides support for family members.
If your illness has been determined terminal, our advance care planning professionals will assist with a seamless transition to hospice care. Making the decision to enter hospice care can be difficult. We are available to answer questions and provide guidance on your specific situation.
We work closely with hospice organizations throughout the area. Your care team will discuss the best hospice care options for your situation with you and your family.
QUESTIONS
Get answers to your frequently asked questions about advance care planning.
Additional Frequently Asked Questions (FAQs) are answered in our recommended Advance Care Planning form.
Q: What is advance care planning?
Advance care planning is process of learning about the choices you have in relation to our future medical care, and how you want to be treated if you are unable to speak for yourself.
These discussions can be very different, depending on your current health. The process includes:
- Learning about medical treatment options and the goals for those treatments.
- Taking time to explore thoughts and feelings about life-saving or life-sustaining treatments.
- Choosing a healthcare advocate to represent your choices if you are unable to speak for yourself.
- Putting your wishes into writing.
Q: If I become too ill to communicate, how can I ensure decisions about my healthcare align with my wishes?
Your choices and wishes of how you want to be treated and cared for when you can no longer speak or make those decisions for yourself is some of the hardest work you must do. Talking with your physician and your family can give you perspective and valuable information. Several options exist for putting wishes for future medical care into writing. Learn more about understanding medical directives.
Q: Do I need to prepare a living will or medical power of attorney?
You are not required to prepare medical directives, which can include living wills and medical power of attorney, but it is the best way to state your intentions about how you want to be treated and cared for if you are unable to communicate your desires. Advance care planning helps your family and loved ones by decreasing the uncertainty, confusion, and conflict about your care. If you don’t name someone to be your healthcare advocate, the Texas Advance Directive Act dictates how decisions will be made with regard to your treatment and sustenance, and these may or may not reflect your intentions.
Q: I’ve documented my wishes, but what if I change my mind through the course of my life and/or illness?
You can change your instructions in medical directives any time. It is advisable to create a new form with your changed desires and discard the previous directive. Make a point to have discussions with your healthcare advocate about your future medical choices, including specifics about when and what medical treatment options you prefer. Be sure to inform your physician and your caregiving team if you change your medical directives.
Remember, the living will or advance directive to physicians will only be referred to when you are unable to communicate your own desires. If you are awake and able to say what you want, you are able to make your intentions known to your care team.
Q: Can someone speak for me if I am not able to communicate what I want for my care?
Yes, a medical power of attorney allows a designated person to speak on your behalf. The person you designate, known as your healthcare advocate, does not have to be a family member and becomes a surrogate for your medical care. It is important for your family and your healthcare advocate to be aware of your decisions and your medical directives. Having these documents completed before they become necessary is advantageous.
Q: How do I choose a healthcare advocate?
Perhaps one of the most important decisions to be made in the advance care planning process is choosing a healthcare advocate. This person is legally empowered to carry out healthcare wishes and decisions when the individual is no longer able to do so.
It’s vital that your healthcare advocate understand the quality of life that is important to you. A healthcare advocate may be a family member, close friend or someone else you trust to make decisions in accordance with your wishes.
Q: Do I need a lawyer to complete medical directive documents?
You do not have to have an attorney draft medical directive documents, and we can assist you. We have forms available to document future healthcare wishes. Upon completion of the forms, you simply need to sign them in front of a witness.
As your Primary Care Provider we may initiate this conversation or be included in it at your discretion. In many cases, patients bring a copy of their Advance Care Plan to us to incorporate into the health record as we are often called when tragedy occurs to determine if we have knowledge of your Advance Directives.
Q: Do doctors, nurses and hospitals have to follow my instructions?
State laws require health care professionals to follow your stated wishes. If a doctor, nurse, hospital or nursing facility is unable or unwilling to follow your written instructions, they must transfer you to a healthcare provider willing to abide by your instructions.
Q: How will my family know to engage palliative care or hospice care?
We closely engage with family members to give guidance about when palliative care or hospice care is needed. Palliative care aims to improve the quality of life and provide comfort for patients with serious illnesses. It includes the management of physical symptoms, as well as the psychological and spiritual challenges that come from coping with a life-threatening disease. Hospice care is designed to maintain a quality of life and comfort level for patients nearing the end of life. A coordinated hospice team including physicians, nurses, social workers, clergy, and volunteers care for patients and provides support for family members.
Creating a written document clearly stating your preferences for future medical care and end-of-life care is an essential part of the advance care planning process. The document will clearly state your values and wishes, as well as support your healthcare advocate in carrying out those wishes.
- A Medical Power of Attorney (MPOA) allows you to legally appoint a healthcare advocate to make medical decisions on your behalf. A medical power of attorney can be enacted even you are not diagnosed with a terminal disease. We can assist you with drafting this document.
- An advance directive (living will) allows you to clearly state your wishes for medical treatment at the end of life. Unlike a medical power of attorney, an advance directive can only be enacted if you are unable to communicate your wishes. Our social workers can assist you with filling out the paperwork to ensure that your decisions are legally protected.
- Most advance directives do not include a Do Not Resuscitate (DNR) Order. A DNR formally states you do not want further medical intervention if your heart stops or you stop breathing. We can help you complete this directive with your doctors and healthcare advocate, if these are your wishes.
Review your advance care planning documents regularly to ensure your wishes and values remain aligned with the formal documents in place regarding future medical care. Be sure to inform your healthcare advocate if you change any documents.