National Healthcare Decisions Day is April 16th! On this day, all across the country, health care facilities, health care professionals, chaplains, the legal community, and others will be participating in a collective effort to highlight the importance of making advance health care decisions and to provide tools for decision-making..
Notwithstanding a much higher awareness on the part of individuals and institutions regarding the need for health care decisions planning, implementation by individuals and institutions of plans meeting the need are still rare. Less than fifty percent of the severely or terminally ill patients had an advance directive in their medical record, according to a study by the U.S. Agency for Healthcare Research and Quality (http://www.ahrq.gov/). In a 2003 article, “Advance Care Planning: Preferences for Care at the End of Life,” USAHRQ reported that only twelve percent of patients with an advance directive had received input from their physician in its development. Moreover, between sixty-five and seventy-six percent of physicians whose patients had an advance directive were not aware that it existed.
Even when the advanced directive exists, and the physician is aware of its existence, most physicians do not consult with their patients regarding end-of-life issues until treatments have been exhausted, at least according to researchers publishing a report in the journal Cancer, reported last month in this blog (click here). According to the researchers, most doctors don't talk about end-of-life issues with their cancer patients when those patients are feeling well. Nor do they talk about them until treatments have been exhausted. Those delays might mean patients are unable able to make truly informed choices early in their treatment.
End-of-life issues medical issues are impacting more Americans. According to one report, forty-two percent of Americans have had a friend or relative suffer from a terminal illness or coma in the last five years, and for a majority of these people and twenty-three percent of the general public, the issue of withholding life sustaining treatment came up. See, "More Americans Discussing – and Planning – End-of-Life Treatment," The Pew Research Center, January 2006.
Most people desire to remain at home as long as possible, despite a worsening mental or physical condition, and most people, if given a choice, prefer to die at home, rather than in a hospital or nursing home. Having a living will is associated with lower probability of dying in a hospital for both nursing home residents and people living in the community, according to another recent study. See, "Brief Communication: The Relationship between Having a Living Will and Dying in Place," Annals of Internal Medicine (2004) at pp. 141;113-117.
Patients and families are also not fully informed of the relevant risks and potential benefits of artificially supplied nutrition and hydration (ANH). Financial incentives and regulatory concerns promote the use of ANH in a manner that may be inconsistent with medical evidence and with the preferences of patients and their families. See, "Appropriate Use of Artificial Nutrition and Hydration – Fundamental Principles and Recommendations," New England Journal of Medicine at pp 353; 24. Because ANH is associated with uncertain benefits and substantial risks, it is essential to ensure that decisions about its use are consistent with the patient’s medical condition, prognosis, and goals for care. Therefore, decisions about ANH require careful consideration of its risks and potential benefits.
To meet these needs and concerns, Monty L. Donohew, LPA, an Ohio Legal Professional Association, and other national, state and community organizations, are joining a massive effort to highlight the importance of advance healthcare decision-making—an effort that has culminated in the formal designation of April 16 as National Healthcare Decisions Day (NHDD).
NHDD organizers are asking interested organizations and individuals throughout the country to help raise awareness about the importance of advance care planning on this special day -- and throughout the year. To help realize this goal, they have created a web site with information and tools for the public to talk about future healthcare decisions and execute written advance directives (healthcare power of attorney and living wills) in accordance with their applicable state laws.
The web site also includes tips on how advocates can raise awareness in their communities. In addition to signing up your employer or organization to participate, here are some of the ways you can help this important cause:
- First and foremost, lead by example…be sure you have thoughtfully considered and made your own healthcare decisions known.
- Become a fan of a facebook page dedicated to informing people of NHDD.
- Next, make sure everyone in your organization, workplace, or family is informed about NHDD (including staff, board of directors, volunteers and others) and ask for their involvement to promote NHDD in your community.
- Provide a link on your organizational web site to nationalhealthcaredecisionsday.org. It features a variety of information for the public and providers on advance care planning.
- Set up an exhibit about NHDD at your main entrance and offer information about advance care planning as people come by.
Distribute NHDD promotional materials and advance care planning educational brochures at upcoming community events or health fairs.
Although several states have engaged in advance directives awareness events and numerous organizations have devoted substantial time and money to improving education about advance healthcare planning, only a small minority of Americans has executed an advance directive. NHDD seeks to address this issue by focusing attention on advance healthcare planning from a variety of directions simultaneously.
Organizations and coalitions interested in participating are encouraged to sign up at the NHDD Web site. If you would like materials for your organization, place of business, or family, or a speaker for an event, please call Christine at 877-816-8670.
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