Advance Care Planning : Five Promises of Advance Planning : Provide assistance

This promise reflects the need to define the components of an advance care planning process and the need to shift the focus from the completion of a document to quality conversations. It also involves evaluating what "assistance" means, taking into consideration differing degrees of acceptance of the stages of chronic illness and differing religious, cultural, and spiritual perspectives related to decision-making. This promise includes a commitment to improving patient understanding of treatment options, assistance with setting goals and weighing the benefits and burdens of a proposed intervention. This promise encompasses a commitment to shared decision-making between an individual, their loved ones, and the health professionals who care for them.

In evaluating whether an organization or community is meeting this promise, the following questions could be asked:

• What does "assistance" mean? Is advance care planning defined as a process of assisting an individual to understand, reflect and discuss theri relevant treatment choices, or does it refer only to the completion of a written document?
• Are individuals well informed of what advance care planning as well as advance directives consist of?
• Are patient's treatment preferences re-explored with changes in their medical condition or response to treatment?
• Is information about advance care planning routinely provided to groups within the community?
• What are the qualifications of those providing assistance with advance care planning? Is there a training program for professionals? Are there well defined roles of the various professionals who assist with advance care planning? Is there an adequate number of qualified professionals available in all health care settings?
• What is the satisfaction with the current practice of advance care planning? Is there documentation of advance care planning discussions? Do professionals feel there is time to engage in quality advance care planning? Are patients and families satisfied with the quality of advance care planning discussions? Are advance directives completed well before a medical crisis?

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