Advance Care Planning (ACP) is a vital process that encourages patients to reflect on their values, beliefs, and health care preferences for the future. It involves sharing these insights with loved ones and health care professionals to ensure that one's wishes are respected and honoured. Studies have consistently shown that ACP not only improves patient outcomes but also enhances the efficiency of healthcare systems. On Tuesday, April 16th, we join communities across Canada in commemorating Advance Care Planning Day, an occasion to underscore the significance of these conversations.
"It is critically important that patients and their loved ones be part of an advance care planning discussion and that health care providers be transparent about disease trajectory, death and dying," says Diane Edlund, whose family member was treated for metastatic colorectal cancer. "It is imperative we understand what that future might look like, and healthcare providers can help us do that. I am the circle of care for my person, and I will be with them in the end. It is important for me to be prepared and part of their advance care planning process so that I can ensure my loved one has a positive experience throughout their care journey and at the end of their life."
This year's Advance Care Planning Day holds special significance. It comes on the heels of the approval of a new ACP policy in January and the addition of a new ACP Lead role to integrate and support advance care planning across all clinical service portfolios; both marking significant steps towards fostering patient-centered care. The policy promotes evidence-based, self-determined, and person-centered practices in ACP throughout PHSA and includes responsibilities that health care professionals identify and address any cultural and spiritual considerations and ensure the process is culturally safe and relevant for Indigenous Individuals and families.
"Advance care planning is important for Indigenous people and their families both to ensure their cultural beliefs and values are understood and respected, and to provide clear direction for family members who might be making decisions on that individual's behalf during an already challenging time for the family," says Warren Clarmont, executive director, Indigenous Health & Cultural Safety at BC Cancer.
The foundation for this policy was laid by the exemplary work already underway at PHSA. Both BC Cancer and BC Renal were early adopters of the Serious Illness Conversation Program, implemented shortly after its release in 2015. This program integrates the use of the Serious Illness Conversation Guide into the care of patients facing serious illnesses. Across PHSA, numerous clinicians and care providers have been trained in utilizing this guide, which serves as a valuable tool in facilitating meaningful conversations with patients about their illness understanding, decision-making preferences, prognostic information, and care plans.
Further, the integration of CST Cerner holds immense potential in advancing ACP initiatives across PHSA and VCH and Providence Health Care. Dr. Michael McKenzie, a radiation oncologist at BC Cancer, is at the forefront of this effort, spearheading quality improvement initiatives to incorporate CST Cerner ACP PowerForms into team-based care. Working in tandem with Dr. McKenzie is research nurse Heather Kilgour from BC Cancer's Nursing and Allied Health Research and Knowledge Translation Department. Together with patient and family partners, as well as leadership and nurses from all six cancer centres, they are collaboratively designing new ACP standard practices. Their aim is to equip nurses with the knowledge, confidence, and resources to engage in ACP discussions with patients effectively, thereby enhancing access to advance care planning for patients and their families.
At BC Renal, Sherri Kensall, vice-chair of the BC Renal Palliative Care Committee has been working on two important resources: an Integrative Palliative Nephrology Resource Guide and from a renal perspective, supporting the development of a BC Centre for Palliative Care Learning Pathway for Palliative Care Skills. The first aims to integrate nephrology and palliative care to improve quality of life and supports ACP as a single document integrating palliative nephrology along with key resources through BC Renal and other trusted resources. The Learning Pathway for Palliative Care Skills is a free, self-directed course where health care providers can access resources curated by experts for the 12 domains within the palliative care competency framework.
As we observe Advance Care Planning Day, it's essential to recognize the ongoing efforts within PHSA to prioritize patient-centered care through initiatives like the new ACP policy. These endeavours underscore our commitment to honouring patients' wishes and providing compassionate, personalized healthcare tailored to their needs.
Having an Advance Care Plan is important for everyone, regardless of their current health condition.
Those with an ACP are more likely to be satisfied with their care, will require fewer aggressive interventions at the end of life and are more likely to take advantage of hospice resources or die at home.
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