Hide Comments from the Advance Healthcare Directive

Aug 6th, 2022
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How to Hide Comments from the Advance Healthcare Directive

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In this tutorial, Neil Winger, a primary care physician affiliated with the UCLA Health Ethics Center, discusses advance directives. An advance directive is a legal document that specifies the medical treatment you wish to receive if you are unable to make decisions for yourself. This situation may arise if you are too ill or incapacitated. The purpose of advance directives is to guide doctors in making medical decisions that align with your preferences when you cannot communicate. It’s essential to designate someone, such as a spouse, sibling, or friend, to make choices on your behalf; otherwise, medical professionals may not know whom to consult.

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These included: family members difficulty accepting a poor prognosis, lack of family agreement in the goals of care, difficulty understanding the limitations of life-sustaining treatments, lack of patients capacity to make goals of care decisions, and language barriers.
Physician barriers to completing an advance directive include lack of time and discomfort with the topic. On the patients part, lack of knowledge, fear of burdening family, and a desire to have the physician initiate the discussion are common barriers.
Advance directives have limitations. For example, an older adult may not fully understand treatment options or recognize the consequences of certain choices in the future. Sometimes, people change their minds after expressing advance directives and forget to inform others.
The advance directive allows you to make specific written instructions for your future health care in the event of any situation in which you can no longer speak for yourself. It outlines your wishes about life-sustaining medical treatment if you are terminally ill or permanently unconscious, for example.
In addition, family members were reluctant to disclose medical information to the patients or to involve the patients in decision making. Family-centered decision making. Doctor-centered decision making. Avoidance of decisional conflict. Prioritizing positivity over life and death. Sense of powerlessness.
Advance directives have limitations. For example, an older adult may not fully understand treatment options or recognize the consequences of certain choices in the future. Sometimes, people change their minds after expressing advance directives and forget to inform others.
The research identified six themes related to barriers to completing an advance directive: 1) provider time constraints; 2) education: patients, loved ones, and healthcare professionals; 3) a lack of comfort discussing end of life; 4) culture; 5) advance care planning evolvement; and 6) specialization by non-physicians
If a patient has not previously had an ACP conversation, nurses can teach patients why planning is important. When a patient expresses a desire for advance care planning, nurses can communicate the request to the other members of the healthcare team. Teaching families and caregivers how to initiate ACP conversations.

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