Commentary

Who Decides What Comes Next?

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1. Initiate a guided discussion.
2. Introduce the subject of advance care planning and offer information.
3. Prepare and complete advance care planning documents.
4. Review the patient’s preferences on a regular basis and update documentation.
5. Apply the patient’s desires to actual circumstances.1
(A detailed discussion of these steps can be found at www.ahrq.gov/RESEARCH/endliferia/endria.pdf.)

Now is the time to assist friends, family members, and your patients in discussing and documenting their plans. Take the time to document your own advance directives. Let your family and your health care provider know what you want, and have it put in your health record. Review it annually, in the event that there have been changes in your family or in technology. Do not miss the opportunity to let your family know what you want.

Do you have a plan in place? Share your thoughts by emailing NPEditor@qhc.com.

References
1. Kass-Bartelmes BL, Hughes R, Rutherford MK. Advance care planning: preferences for care at the end of life. Rockville, MD: Agency for Healthcare Research and Quality; 2003. Research in Action Issue #12. AHRQ Pub No. 03-0018.
2. Teno JM, Licks S, Lynn J, et al. Do advance directives provide instructions that direct care? J Am Geriatr Soc. 1997;45(4):508-512.
3. NIH National Institute of Nursing Research. Spotlight on end-of-life research. www.ninr .nih.gov/researchandfunding/spotlight-on-end-of-life-research. Accessed January 22, 2013.

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