Advance care planning helps address the unexpected, including COVID-19
By Brandy Stadnyk
Winnipeg Regional Health Authority
Published Monday, April 11, 2022
It's safe to say that no one planned on getting COVID-19. The same can be said of the many other circumstances that result in someone being admitted to a hospital or long-term care facility.
That's what makes the concept of advance care planning so important.
Simply put, advance care planning is a way to help you think about, discuss, and share your thoughts and wishes about your future health care – before the unexpected happens. It helps ensure that your wishes are known to your family and health-care staff, no matter what the future holds.
Talking about what kind of healthcare and treatments you are willing to accept – and under what circumstances – is what advance care planning is all about. For instance, do you value a long life at the expense of its quality, or is the quality of your life more important to you? Do your values lie somewhere in the middle? These are important questions only you can answer, and which can help guide decisions made by family, friends and health care staff should you be unable to speak for yourself.
Part of advance care planning is thinking about your Goals of Care – goals that reflect your views on the quality-of-life considerations that are important to you based on your values and beliefs, and which will be recorded on your Goals of Care form.
There are three levels of care:
R – Resuscitation: You want to receive all life sustaining treatment options, including cardiopulmonary resuscitation (CPR) should your heart stop beating. You are willing to have blood work or tests completed to help determine what is wrong. You want your symptoms managed if they cannot be treated.
M – Medical: You want to receive life-sustaining treatment options but do not want to receive CPR. You are willing to have blood work or tests completed to help determine what is wrong. You want to have symptoms managed if they cannot be treated.
C – Comfort: You want to receive treatment options focused on managing symptoms and supporting your quality of life. You may not want to have blood work or tests completed to determine what is wrong. You do not want aggressive or invasive treatments.
In addition to the Goals of Care form, you should know that you have the right to accept or refuse medical treatment at any time. In Manitoba, The Health Care Directives Act allows you to create a health care directive (sometimes called a living will) that expresses your wishes about the amount and type of health care and treatment you want to receive should you become unable to communicate for yourself. A health care directive also allows you to assign a proxy, giving another person or persons the power to make medical decisions on your behalf if you are unable to make them for yourself.
Though it can be difficult to talk about "what if" situations involving illness, disability, or death, advance care planning is the best means of ensuring that you receive the kind of care you want. It also helps you avoid putting your family and friends in the difficult position of having to guess about the kind of care you would want to receive in the event you can't speak for yourself.
In addition to CPR, some common considerations include whether you would want to receive treatments such as a blood or blood product transfusions, dialysis, or feeding through a tube. Organ/tissue donation is another common consideration, as is palliative/hospice care.
COVID-related questions might include whether you would you want to have a breathing tube inserted (be on a ventilator) while your body tries to fight the virus. Would your age or chronic medical conditions impact that decision?
When it comes to advance care planning and Goals of Care conversations, there are no “wrong” answers. Be honest with yourself and your family or friends about what is important to you. You can speak generally about your wishes, focus on your spiritual and/or religious beliefs, or be specific in terms of situations or types of care you absolutely do not want to experience.
Not sure where to start? There are many resources online and in print to help you have advance care planning conversations and to help you document your wishes. To find out more about advance care planning and goals of care, visit wrha.mb.ca/advance-care-planning where you can access a workbook (in English & French) to help start your conversations. Additional information (and a helpful video) can be found at advancecareplanning.ca.
Beware these advance care planning myths
Once goals of care are set, they can't be changed.
Goals of Care can and should be re-addressed with any significant change in health such as a new illness or an upcoming surgical procedure. Your Goals of Care are based on your values and beliefs, so while specific situations may change, the foundations of these conversations usually remain the same.
If I opt for comfort care, staff will stop providing me with care.
Rest assured that everyone who chooses comfort care continues to receive treatments, medications, and care focused on maintaining their quality of life. A person experiencing pain can receive pain medication and/or non-medication pain management strategies. A person having trouble breathing or feeling short of breath can receive medication and/or non-medication management strategies to reduce the feeling of shortness of breath.
I'm young and healthy, so there's need to think about advance care planning now.
There are no guarantees in life, and your health can change at any time. You are never too young or too old to start having conversations about your Goals of Care. Doing so now can help ensure that your family and friends are prepared for those “What if . . . ” situations.
I need to know exactly what I want before I start talking about Goals of Care.
When you go to an emergency department or urgent care centre, are admitted to hospital or a long-term care facility, or are preparing for a surgery or other medical treatment, staff will talk to you about your Goals of Care to make sure they can best follow your wishes if you or your family or friends cannot communicate or be reached during a crisis. If you are transferred from one healthcare facility to another, staff will talk to you again about your Goals of Care.
Brandy Stadnyk is Professional Lead – Nursing with the Winnipeg Regional Health Authority