Planning In Dementia And Palliative Care

Importance of ACP in Dementia and Palliative Care

Discuss about the Planning in Dementia and Palliative Care.

This assignment is focused on the case study representing the condition of 46 years old man named Anthony Vella who had been suffering with stage 4 of pancreatic cancer which had been diagnosed six months back after he was presented to emergency department with acute abdominal pain. Anthony had been wedded to Luisa for 20 years; and the couple are blessed with two children, both aged 16 and 19 respectively.

The rest of this assignment emphasizes on the procedure of defining and curating an advanced care plan (ACP) that is generally implemented in such cases, like that of James Smith. As per the design of this assignment, the first course of action is centered on discussing how a conversation session with the patient and the respective family members about crafting an ACP can be introduced and implemented. For any strategy to be successfully implemented it is extremely important to design the strategy carefully, however the very next step that is extremely necessary is the preparation that goes behind the implementation procedure. Hence, in this case as well, the strategizing step was followed by explaining the preparation required for that discussion process. The following section after the preparation procedure discusses the members that should participate in the said ACP discussion, followed swiftly by an elucidation of the necessary informational data needed in devising such a plan. Now, ACP can be defined as the document that has the potential to change over the lifespan of a particular individual, the next requirement is periodic reviewing and amending the ACP; the next section discusses the time limit after which the ACP must be reviewed and amended. The final section of this assignment discusses the activation period of the ACP program as well. Finally, the conclusion of the essay briefly concludes the primary points presented in the entire assignment.

The importance form of the impetus for the development of the ACP derives from the fact that one out of four people dies in the United States that effectively occurs in the nursing homes and also 70% cases are been encountered in the hospitals.

However, little has been observed in the early 1990s, that the statistics have reported that as many as the residents of the nursing home care have been receiving the end of the care of the life that was not in the compliance to the previous patients that have expressed the wishes in the advanced form of directives. In the part that are due to these form of issues, the Institute for Healthcare Improvements that are been producing the set of the principles that have been defining the responsibility of the health care professionals providing care that are holding the ACP form of discussions with the patients. There are five principles, that are represented in Figure 1, offer a framework for designing effective inter- conversation with patients (Adams, Kabcenel, Little, &Sokol-Hessner, 2015).

Preparation for the Advanced Care Discussion

As opined by Adams et al. (2015) in his article, the key strategy instructs the health care professionals to be engaged with the patients and their families so that they can easily determine what care components in the most necessary to them. The model associated with this process instructs the health care providers to be connected with the families of the patients more compassionately and finally connects it with the patients in a specific way that are culturally and also individually been respectful.

Various studies have observed that the home residents with respect to the discussions of the ACP have been found out that too often the discussions also takes place at the time of the admissions that if it occurs at all. In a particular form of situation, there needs to be systematic form of the reviews that are needed to be formed for the four specific studies of the ACP that have focused on the residents of the nursing home and they were found admitting, the healthcare staff often realized that the patients that were incapable for having for having the discussion at the time of their admission. However, it has to be understood that when dementia occurs the cognitive functioning power of the brain is more likely to be compromised, having the ACP conversation prior rather than later had always been a vital issue to ascertain enhanced quality of life.

In the case represented in the assignment of James Smith, these principles or ideologies would initially mean discovering circumstances to connect with Mr. Smith along with his family regarding his EOL care needs. As the cancer care team designated to him had indicated two weeks prior that no additional treatment, except end of life care, would be efficient, the complete newest time for this conversation should actually be at that time. However, the survival rate of stage IV pancreatic cancer is only a window of five years time (ACS) (American Cancer Society, 2016). As per the condition that the patient under consideration is in the life expectancy for the patient is not more than five years, hence the ACP talk preferably been held immediately after diagnosis, in case that Mr. Smith had not arranged an ACP or AD in advance.

The early ACP discussion just after the cancer diagnosis will increase the likelihood of the patient engaging in design and implementation of a patient centered ACP (Der Schmitten, Lex, Mellert, Rothärmel, Wegscheider & Marckmann, 2014; Houben, Spruit, Groenen, Wouters& Janssen, 2014). Additionally, it also needs to be considered that the AD documents that are completed after a successful ACP discussion are extremely beneficial for the traetmentv plan to follow, studies suggest that thes4e documents not provides relevant data regarding the severity of the patient as compared to the data collected without a valid ACP discussion with the patient (Der Schmitten et al., 2014; Garrido, Idler, Leventhal& Carr, 2012). Another fact can be considerd completing both the documentation, AD along with ACP, considerably enhances the possibility of patient preferences being valued and complied along with being tended so that that care that complies with the preferred care requirements is provided  (Brinkman-Stoppelenburg, Rietjens& van der Heide, 2014; Houben, Spruit, Groenen, Wouters, & Janssen, 2014).

Adams et al. (2015) opined an imperative assortment of different steps that can be implemented by a healthcare providing organization to arrange and carry out ACP discussions with patients along with their family members. Although, the steps are not completely characterized still, utilizing the five different principles represented in the Figure 1 the IHI that characterizes main steps in planning to carry out these discussions. As per the findings of Adams et al. (2015), the initial phase of organization is to employ the connect population to care planning procedure so that they can interpret the number of patients that have already been selected a healthcare proxy, the number that have successfully documented their “what matters” issues, and of those without either or both of those documents, how many of them were asked to contemplate those issues. The stewardship part of the entire preparation cycle comprises of documenting the data from healthcare proxy and “what matters” concerns within the records of the patients (Adams et al., 2015). The concept of exemplify principles indicate at exploring the exact figure of the health care workforce that have on their own discussed about ACP with their own families, and recorded their ACP and the “what matters” wishes along with having a advanced healthcare proxy that is recorded (Adams et al., 2015). The majorly difficult aspect of the entire preparation procedure is crafting a strategy that can employ the spiritual, philosophical, and cultural beliefs of patients even if those beliefs are potentially quite dissimilar from healthcare staff (Adams et al., 2015).

In case of Mr. Smith, there had been no data provided that discusses his spiritual or cultural setting, neither were any recorded documentation about his “what matters” wishes; the patient even lacked a legal healthcare proxy to take clinical decisions in behalf of him in times he was incapable of response.

The ACP conversation can engage a varied amount of several healthcare givers. However, it must necessarily include the patient his family members. With respect to Mr. Smith, the ACP discussion procedure should also have included one or more individuals belonging to the cancer care team he was assigned, it is not mandatory for the oncologist to be included, but someone skilled to carry out ACP discussions (Adams et al., 2015). In case the ACP discussion have not been carried out as an element of the cancer treatment plan he was designated, as suggested by the ACS, the primary instance he had been taken to the health care facility, a specialist must have had ACP conversation with Mr. Smith and the members of his family (American Cancer Society, 2016). Given that he had been pursued by the emergency department it can be interpreted that the patient had been in a critical condition, hence, it can be concluded that having the ACP discussion with the patient much earlier would have been far better. Now in case none of the above healthcare professionals discussed ACP with the patient, it would be extremely necessary for initiating the discussion by the primary physician.

The main difference between the ACP document and a DNR (Do Not Resuscitate) is that the information provided by ACP documents is much more inclusive than the latter. The recommendations of the IHI indicate that an ACP must initiate with recording the answer given by the patient to  “What matters to you?”  (Adams et al., 2015). The questions belonging to this genre reveal the aspects of life that are most central to the patient and put in largely to the quality of their life. Furthermore, the ACP is also known to typically include a living will that describes the types of treatment procedures the patient wishes to undergo, along with providing a strong power of attorney which nominates some other individual to take the medical decisions on behalf of the patient in times when he or she is not capable of making those decisions on his own, and documents choices for organ and tissue donation, durable healthcare power of attorney, and religion documentation, cultural, or interpersonal for procedures like dialysis or cardiopulmonary resuscitation (CPR) (National Institute on Aging, 2016).

McMahan, Knight, Fried, and Sudore (2013) researched the factors that the patient families and the patients themselves felt were most important in preparing an ACP. The suggestions from the particular study incorporated typical AD forms, but at the same time identifying and documenting the factors that were deemed as most crucial, ensuring the care proxy designated for the patient (the person particular in the durable power of attorney) understood their role in clarity, determining whether flexibility should be allowed to the surrogates in decisiveness or adhere strictly to preferences that the patient has previously expressed which helped in the family member or friends knowing the patient’s wishes  (McMahan et al., 2013).

A chief aspect in this context is to ensure ACP being safely documented in a manner that can be effortlessly understood, for the patients that are not very fluent with English or those who do not understand legal terminologies; the ACP documents ensures that everyone associated with the patient and the treatment procedure selected for him is equally involved, from family and friends of the patient to healthcare providers, everyone is clear about wants and needs of the patient. Robinson et al. (2013) distinguished that healthcare providers frequently discover ACP plans are very critical to incorporate into a clinical setting due to the concerns of complicatedness in making the legal documentation comprehensible, concerns with ambiguity in the legal background of the different documents, and concerns with differences between patient preferences eventually (Robinson et al., 2013).

For Mr. Vella, his ACP comprises of a strong power for the attorney for allowing his wife and the other members of the family for making the decisions of this healthcare when he was very much incapable for doing so. Moreover, it should the core responsibility of his wife to give his proxy, should have been aware of all her responsibilities, and should know about Mr.Vella’s have expressed their form of needs in the care plan. Since he had not been responding when he was admitted to the health care facility in the last event, he was also incapable to make healthcare decisions on his own regarding his conditions. Furthermore, a DNR would have potentially avoided extreme measures required otherwise to revive him, and organ and tissue donation forms serve as the means to permit his needs related to those issues are respected.

According to the recent studies, the perception of the cancer patients regarding the ACP is a very dynamic one, the cancer patients often find is to be a potent device rather than being a permanent decision that is made only at one time. Michael et al. (2013) discussed the nature of response that the cancer patients have shown to ACPs over the course of their diseases. The patients who are suffering from cancer has been often  found out that the ACP is a very dynamic form of the instruments rather than the fixed form of decisions that are been fixed form of decisions over the course of the disease. American patients with the incurable form of the pancreatic cancer like Mr. Velle, it has been observed in their medical reports shows only about fifteen percent of the times. Moreover, the DNR orders have also shown that the cancer patients are overpoweringly signed after the day that the patients died, either by the patients or by the proxies belonging to the healthcare systems. In one of the study by the Australian cancer patients, discovered that the extent of awareness in the public and utilization of different components of ACP (like living will, DNR orders, and more) varied extensively amongst different participants, along with the fact ACPs were tremendously changeable to cancer patients, that were unusually sought to judge various aspects of ACPs during various phases in their disease procedure. The most evocative declaration that the participants made had been that the ACP was “an iterative process” (Michael et al., 2013, p. 2198).

With respect to the case represented by Mr. Vella, the ACP discussions it ought to be at a minimal form of level that are needed to be addressed at the time of the initial form of the diagnosis of the cancer, if it is not done before. As every stage of the protocol of his treatment was concluding, the plan has never been revisited for ensuring that Mr. Vella’s desires were also with accordance to the alignment with the plan. This form of literative form of process ensures that Mr. Vella wishes were documented and updated with accordance to his physiological health and his process of the disease have also altered.

The commencement procedure of ACP program is actually established on the specific situation of the patient. It has been observed that in cases when the ACP is designed and characterized by Michael et al. (2013), the commencement of the ACP plan that may take place for the over the longer period or the from time to time. For instances, to have a proxy refers to the fact that when the patient becomes incompetent and looses the capacity of making the healthcare decisions, they designated form of the proxy becomes ultimate for the patients. A circumstance where a patient is incapacitated for a short period of time which can lead to an ACP being initiated in advance until the patient can make clinical decisions on their own. Adams et al. (2015) in his article has suggested that if the entire healthcare industry propagates towards achieving the five conversation-ready principles, which are considered to be fitting stewards of the patient wishes, ACPs in most cases can be efficient and dependable for all kinds of patients. For Mr. Vella, the ACP was supposed to be performed at the time he was initially taken to the emergency department and had been unable to communicate his desires or preferences regarding his healthcare.

Conclusion

The above paper addresses the issue for the advancing care planning for the patients in the context of Mr. Anthony Vella, the cancer patient suffering with the Stage 4 of pancreatic cancer. The situation that Mr. Vella had been in highlighted the significance of preparing for the carrying out the conversation about the ACP much earlier than the disease left the patient had not been responding. The instrumental structure of elements of ACP that incorporated a living will, ADs concerning patient desires for activities to be carried out on him, choices for organ and tissue donation, durable healthcare power of attorney, and religion documentation, cultural, or interpersonal for procedures like dialysis. The ACP plans here are nothing but appropriate iterative procedures instead of being a one-time permanent set of main decisions, along with that are accurately performed earlier in the course of diagnosis and treatment, the moment a potentially severe or grave condition is diagnosed and during disease progression. Commencement of the ACP happens each time the patient’s situation requires major measures being contemplated.

References

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