1. Communication | Choice | Respect
Advance Care Planning
Communication | Choice | Respect

2. Our vision
At some time, in some way, we must all face the end of life. And most of us share a common hope – that when death comes to us or to a loved one, it will be peaceful and free of pain. We hope to face death surrounded by those we love, feeling safe, comfortable and cared for.

3. Advance Care Planning: Definition
Advance Care Planning (ACP) is a process of reflection and communication.
It is a time when you reflect on your values and wishes regarding your future health and personal care in the event that you become incapable of consenting to treatment or other care.  
Capable: to be capable of making personal care choices means that you can understand the information that is relevant to making a decision about your health care, nutrition, shelter, clothing, hygiene or safety, and can grasp the likely results of making the decision or not making it. Capable of giving informed consent- info about tx, risks, alternatives, outcomes etc.

4. Advance Care Planning: Definition
It means having discussions with family and friends, especially your Substitute Decision Maker – the person who will speak for you when you cannot.
Write down your wishes, and talk with your doctor, health team or legal professional.

5. What is a substitute decision maker?
The person named in your plan, who will make medical decisions on your behalf when you are incapable of communicating your wishes because of illness or injury.
Will give or refuse consent to treatments proposed by a health practitioner if you are incapable of consenting yourself.
In Ontario this is referred to as the Power of Attorney for Personal Care.

6. How do I choose a substitute decision maker?
Choose someone who you trust and feel will be comfortable carrying out and communicating your wishes.
Have the conversation
it’s important that your substitute decision maker knows about their role and your wishes.

7. Why is ACP important? Research has shown that:
If you have an advance care plan you are much more likely to have your end-of-life wishes known and followed.
Your family members will have less stress and anxiety –because they know your wishes.
You will be more satisfied with your care as will your family and substitute decision maker
You will have a better quality of life and death

8. Making a Plan
My VOICE

9. How to begin 1. Think about what’s right for you
2. Learn about end-of-life care options and medical procedures
3. Decide who will make decisions for you if you cannot

10. 5. Write down or record your wishes 6. Review your plan regularly
How to begin
4. Have the conversation
5. Write down or record your wishes
6. Review your plan regularly

11. Use a Workbook To think about and write about your values and beliefs
To learn about end-of-life care and medical procedures
To write about your preferences for care
To name your substitute decision maker

12. Some things to think about…
What will be right for me at end-of-life?

13. Some things to think about…
If I were nearing death, what would I want to make the end more peaceful for me?
Family and friends nearby
Dying at home
Having spiritual rituals performed
Dying in the hospital
Dying in a hospice

14. Some things to think about…
When I think about death, I worry about certain things happening…
Struggling to breathe
Being in pain
Being alone
Losing my dignity

15. Summary
A process of reflection and communication about values, beliefs and goals of care
A process of planning for a time when a person cannot make their own medical decisions
A process that involves discussions with health care professionals and significant others – and the identification of a substitute decision maker
A process that may result in a written advance directive

16. Have conversations about what is important to you at end-of-life and write down your wishes!

17. Test your understanding
Which of the following people should have an advanced care plan?
A) 51 yr old female with cancer
B) 33 yr old female with good general health
C) 58 yr old male with heart disease
D) 82 yr old male living comfortably in a nursing home
Answer:
All of the above

18. It’s about conversations. It’s about decisions
It’s about conversations. It’s about decisions. It’s how we care for each other.