By: Melody Rabor-Dizon
Not wanting to sound morbid, but all of us have a timetable. If there is anything constant in this world, it is that we are here for only a short time. Last time I checked, the likelihood for any human being dying is 100%. Hence, it is important to talk about our affairs and the people we leave behind.
Talking about advance care planning or 5 wishes for the most part is an uncomfortable subject. It may be treated as, you are hastening someone’s time here on earth for inheritance money, yet to some, it becomes a relief as it gives direct instructions what the patient wants done if in case she/ he cannot speak anymore nor have the ability to decide. It is tension-producing on both ends.
5 wishes is a tool to utilize as one goes through the steps of making their wishes known before they pass or after they pass. The framework provides clear instructions and step-by-step guidance, simplifying the process opening up diffi cult conversation between family members about health care treatment decisions and preferences for comfort, communication and care. It is considered a legal document that stays with you and your primary provider.
Allow me to shed light on how these things can be talked about. Not to say, I do not get any resistance from patients or family as there are so many emotional baggage, experiences or fear of the unknown that lies beneath.
Per 5 wishes, advance care planning conversations improve patient and family satisfaction with care, reduce unnecessary hospitalizations, and increase timely enrollment in hospice and palliative care. In addition, advance care planning conversations foster meaningful communication between you and your provider about health care preferences and what matters most to you. Patients say they want clinicians to be direct, honest, sensitive, and to explain why advance care plans are important, yet most do not have in-depth discussions with providers to help them decide their wishes for care.
Medicare and most private insurers recognize the value of advance care planning, so these conversations are now billable and reimbursable.
WHEN TO HAVE FIVE WISHES CONVERSATIONS
Advance care planning conversations are relevant for every patient over the age of 18, especially those patients with chronic conditions or serious illnesses. Five Wishes works for having one conversation or a series of conversations over time. It is important to initiate advance care planning conversations in the following situations:
• During annual wellness visits with their provider
• When there is a new diagnosis of a chronic condition or serious illness
• When there has been a signifi cant change in an existing medical condition (a decline or an improvement)
• When there has been a change in your social support system or family network, such as a marriage, divorce, death in the family, etc.
• When there has been a change in your care setting
• When you are able to thoughtfully consider and clearly make decisions Five Wishes Conversation Guide
1. WISH ONE: CHOOSING A HEALTH CARE AGENT
• Explore family issues, past experiences with loved ones at the end of their lives, or other considerations that might shape the choice of a health care agent.
• Know the characteristics of a good health care agent
• Review the responsibilities of a health care agent and whether you think that your choice is a good fi t for these tasks
• Encourage to have conversations with their chosen health care agent, and all of the people in their life who might be interested in their health, and their health care choice
2. WISH TWO: MEDICAL TREATMENT DECISIONS
• Explore any experiences you have had that might infl uence your end-of-life treatment choices – experiences with family or friends at the end of life, previous medical experiences, or stories you have heard
• If you have a chronic or serious condition, explore concerns, fears, and questions about your condition and the likely complications or scenarios that may occur near the end of life.
• Know about options for symptom management if fears of pain or discomfort are affecting treatment choices.
• Identify what would be most important to you at the end of life, and what you would or would not be willing to compromise.
3. WISH THREE: PHYSICAL COMFORT
• Explain your wishes for physical comfort are important and that agents knoiw the too.
• Be inquisitive re: physical comfort and pain management.
• If you have a serious illness or chronic condition with symptoms that may increase, plan your needs for further information and resources regarding symptom management.
• Explore your understanding of hospice care and local hospice resources, and obtain more information if needed
4. WISH FOUR: DIGNITY AND SUPPORT
• Explore what brings dignity and meaning to you and how these values affect your care preferences.
• Explore any concerns or questions about how the care team might carry out your care preferences.
• Have conversations with your loved ones about your choices
5. WISH FIVE: COMMUNICATION WITH LOVED ONES
• Share their completed Five Wishes document with their loved ones, their health care agent, and all other health care providers.
QUESTIONS TO GET YOU STARTED
• What is your understanding of your (medical condition or illness)?
• Would you like more information about your (medical condition or illness)?
• What experiences have you and your family had with end-of-life care decisions?
• Start fi ltering people you want to choose as your health care agent and why did you choose that person
• What experiences have you had that affect the kind of treatments you do or don’t want?
• What are your concerns about symptoms or complications that you might experience at the end of life?
• When you think about dying, what do you imagine will be most important to you?
• What brings you comfort and peace of mind ?
• How do you want your pain and symptom managed for physical comfort?
• What questions do you have about hospice care?
• What would help you feel dignity and meaning at the end of your life?
• What is most important for your loved ones to know about you?
• Please share your advance care planning choices, as well as your thoughts and feelings about these issues with your other healthcare providers, your family members, and anyone who might have an interest in your health.
Viatimes family, as hard as it is to talk about death, it is part of life, it is part of your health and part of your care. Planning is very important because on many occasions when there is no advance directive in place, we, as your healthcare team struggle to do what is best and what your wishes are. There are times that patient needs to be resuscitated but there are also some times that they do not want to be especially those with terminal illness. It is not bad to think ahead and your family will be thankful knowing they complied with your wishes. After all, in the end, our family will be the ones either carrying the burden or will be freed from their decision because of your directive.
Your advocate, Melody Dizon, RN