Sourcebook : Improving Care for the End of Life : 5.2 Use or Adapt Comprehensive Advance Care Planning Forms

Planning is far more than what most patients and many providers believe it to be - that is, it is far more than just "pulling the plug" or turning off a machine. Instead, advance care planning can and should include discussions and document plans that address the "ifs" and ambiguities of living with chronic illness, such as:

• Role of the family, including their interests and well-being, and their authority to revise advance care planning documents
• CPR/DNAR (cardiopulmonary resuscitation and "do not attempt resuscitation" orders)
• Respirator
• Hospital transfers and placement issues (including home)
• How assets and benefits are to be used
• Treatment options
• Pain management
• Hydration issues
• Artificial nutrition
• Blood transfusions
• Organ and tissue donation
• Medical device donation
• Plans for cremation or burial, funeral or memorial services

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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved. For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].