End of life planning eases health care choices
End of life planning was addressed by Roberta Loeffler, MD, FACP, FSM and Karen Lehman, DNP, MSN, APRN, FNP-C of Newton Medical Center at Wednesday's session of Bethel College's Life Enrichment series.
Also referred to as advance care planning, the details of how a person wants to die can include more than just their preferences on resuscitation, feeding tubes and ventilators.
"It should involve goal setting," Loeffler said "What matters to you? What does it mean to you to be alive? Who speaks for you?"
More than half of end of life discussions happen in the hospital when emotions are high, patients may not be able to communicate and family members may be unavailable.
"It's the wrong place and the wrong time," Loeffler said.
Having conversations about what measures a person is comfortable with taking to prolong their life before those decisions are necessary can mean better quality of life for a patient and less stress and anxiety for their family and friends.
Lehman noted that, in her work, she often goes to a patient's home after they are dismissed from a hospital stay to talk with them about advance care planning.
"When we do these discussions at home, we are outside the stress of the hospital, the patient is feeling better, they can think clearly and we can recruit family members to come and join us and engage in the conversation," Lehman said.
In talking with patients, Loeffler said most people express a desire to die at home, surrounded by family and friends. That option is trending upwards as more people take advantage of hospice care, but the majority still die at the hospital or in nursing homes, where family members may push for more acute measures to be taken out of fear of losing their loved one.
"With so many treatment options available, advance planning really is important so your choices are respected," Loeffler said. "...I have yet to have a patient tell me, 'keep me alive under any circumstance.'"
Loeffler emphasized the need for patients to talk with their doctors and family about their end of life wishes.
"Unfortunately, death is discussed in generalities and is rarely discussed personally and with respect to your wishes," Loeffler said.
Putting your health care directives on paper makes it much more likely your wishes will be followed.
"There are benefits to the patients, to the family and to the medical team," Lehman said.
Forms that should be filled out in advance include a notarized durable power of attorney form to appoint someone to make health care decisions if you are incapacitated.
"This can also include the decision to put you in a nursing home, if needed, or to transport you across state lines if necessary or to file legal action," Lehman said. "...We actually recommend that anyone over the age of 18 have a Durable Power of Attorney. Eighteen-year-olds can die in a car crash, just like anybody else."
By filling out a living will, you can delineate your wishes about specific health care treatments if you're critically injured or are terminally ill. Both your doctor and your family should be given copies of the durable power of attorney form and your living will.
A Do Not Resuscitate form notes your decisions about receiving CPR, defibrillation, medication and intubation.
"You're less likely to have CPR and hospitalization if you have that DNR order," Lehman said.
A pink Transportable Physician Orders for Patient Preferences (T-POPP) form contains an overview of all your choices regarding health care and must be signed by your doctor.
"This form is often placed on refrigerators in patient's homes so that when EMS comes in, they can see the T-POPP form and those are medical orders that they can follow," Lehman said.
"It is important to have them in writing," Loeffler said. "You don't have conflicts; the documents are legally binding so it makes a difference."