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Start the conversation: Planning for death comforts patients and families

 
Start the conversation: Planning for death comforts patients and families

RN Linda Doelman helps patients and their families talk about Advance Care Planning.

We plan births, families, weddings and parties and painstakingly map out our education and careers. So, asked Linda Doelman, doesn’t it make sense to plan for death as well?

Doelman, an RN in The Ottawa Hospital’s hepatopancreatobiliary surgical program, advocates for Advance Care Planning (ACP). The patients she sees want to talk about death – they want to know how long they have left and what they can expect – but often, they’re afraid to ask. So, she eases them into the discussion slowly.

“It’s a step-by-step process. It doesn’t happen all at once,” she said. “We encourage the family to be here so they can listen, so that their loved one can make their wishes known while they’re still healthy.”

Doelman started introducing ACP discussions after taking the LEAP training run by Advanced Practice Nurse Lynn Kachuik. The course helps health-care providers learn how and when to have these conversations. (See related story.)

Kachuik has trained nearly 100 nurses and doctors in ACP and has mentored Doelman, who has done an exemplary job of embracing the practice. “That’s exactly what we want to happen,” said Kachuik.

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In the hospital, ACP conversations often begin with the surgeons, who should have honest and open conversations with patients to lay out treatment options. Doelman ensures people have all the information they need to make their decisions, and then offers support.

“If they’ve made that decision – not to have chemo or not to have surgery – then we start to talk about the resources that exist to help them plan for the future,” she said. “It’s about making sure their quality of life is the best it can be.”

Many family doctors are able to provide palliative care and help patients manage their symptoms, so Doelman usually calls the family doctor first.

“Sometimes patients come into Emergency or the ICU and their families don’t know what they would want. Families are anxious and they worry about making the wrong decision,” she said. “If everyone knows the plan, then the patient goes through their end-of-life journey comforted, knowing their wishes will be upheld, and the family knows what to do.”

When to review an Advance Care Plan:

  • Annual physical
  • Any change in health status, e.g. when diagnosed with a life-limiting disease
  • Any change in care setting, e.g. moving from home to long-term care

Benefits to effective Advance Care Planning:

  • Improved quality of life for patients
  • Improved quality of death for patients (their wishes are respected)
  • Improved symptom control
  • Reduced psychological distress for patients and families
  • Reduced use of inappropriate treatments
  • Prolonged survival for patients
  • Reduced health-care costs
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