The objective of Advance Care Planning (ACP) is to help
ensure that patients receive medical care that is aligned with their
values, goals and preferences.
Advance care planning: "Let's get talking"MS Trust
This presentation by Dr Jo Poultney, Dr Sarah MacLaran, and Dr Julia Grant looks at advance care planning and how to support patients to express their preferences about care: what they do and don't want to happen and the people important to them.
It was presented at the MS Trust Annual Conference in November 2014.
Advance care planning: "Let's get talking"MS Trust
This presentation by Dr Jo Poultney, Dr Sarah MacLaran, and Dr Julia Grant looks at advance care planning and how to support patients to express their preferences about care: what they do and don't want to happen and the people important to them.
It was presented at the MS Trust Annual Conference in November 2014.
Dr. Elizabeth Paulk gives an excellent review of palliative care topics including end of life discussions, hospice, pain management, and family counseling.
Global health care challenges and trends_ bestyBesty Varghese
GLOBAL HEALTH CARE CHALLENGES AND TRENDS: Analyses the global healthcare trends and challenges.
Healthcare providers have a unique window of opportunity to embrace efficient new technologies that directly support better healthcare and patient experiences at a lower cost.
New healthcare systems will be:
Evidence- and prevention-based
Interdisciplinary and coordinated
Transparent, accessible, accurate, and understandable
Focused on improving patient outcomes and experience
Based on partnerships among stakeholders
Visionary in their long-term thinking
And in total International health + Global public health + Collective health + Global health diplomacy = LIFE’S RIGHT.
Start the Discussion: The Importance of Advance DirectivesSummit Health
We will discuss the importance of planning ahead about end-of-life decisions, provide useful information about how to prepare advance directives, and distribute sample forms.
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
Keynote address by Anna Dixon (Chief Executive, Centre for Ageing Better) at the Royal College of Occupational Therapists Older People Annual Conference 2017.
Geriatric Population. Geriatric Palliative and End-of-Life Care.Michelle Peck
During your journey through this slide deck Geriatric Population. Geriatric Palliative and End-of-Life Care you will experience what it means to die badly.
After practicing as a Geriatric Clinician for over a decade what I know for sure is: Life is a tremendous gift. 100% of us are going to die. If you don't communicate your end-of-life plan, then you should plan on dying badly.
In The Cost of Dying: End-of-Life Care on CBS 60 minutes Steve Kroft interviews Doctor Ira R. Byock. “Families cannot imagine that there could be anything worse than their loved one dying, but in fact there are things worse, generally it’s having someone you love die badly.” ~Doctor Ira Byock
“Dr. Byock what do you mean dying badly?” ~Mr. Kroft
“Dying suffering, dying connected to machines, denial of death at some point becomes a delusion and we start acting in ways that make no sense whatsoever.” ~Doctor Ira Byock
A majority of Americans say they want to die at home. Why is this not happening?
Place of death should be regarded as an essential goal in end-of-life care.
Let’s explore how the end-of-life decision occurs?
For Doctors
Bernacki & Block (2014) found in their review and synthesis of best practices that physician attitudes, training, and perceptions of feeling inadequate in managing the emotional and behavioral reactions of patients all play a role. A majority of trainees were not taught how to communicate and they express strong desires to learn more. Physician barriers also include not addressing psychosocial concerns, placing focus on diagnoses, treatments, and procedures during discussions about the medical care at the end-of-life.
For Patients
Bernacki & Block (2014) found that patients who do bring up dying concerns with their physicians often meet barriers and often are not aware that they are at the end-of-life. Patients that have not set goals based on meaningful conversations about their desires may overuse life-prolonging treatment and underuse services that support quality of life.
Conclusion
Bernacki & Block (2014) found that there is a large body of evidence demonstrating that early discussions of serious illness care goals are associated with:
♛ beneficial outcomes for patients,
♛ no harmful adverse effects, and
♛ potential cost savings.
Apply & Do
To prevent dying badly start early conversations, enhance your knowledge and establish goals. Dreams are only dreams until you write them down. When you write dreams down then they become goals.
Do ♛ The Conversation Project a collaboration with the Institute for Healthcare Improvement. http://theconversationproject.org/starter-kit/intro/
Do your conversation kit now and make your loved ones aware of your wishes.
Wishing you the very best, Michelle
Bernacki RE, Block SD, for the American College of Physicians High Value Care Task Force. Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices. JAMA Intern Med. 2014;174(12):1994-2003.
Health literacy is the most important factor in getting the proper health information and health services. Health literacy significantly affects healthcare accessibility, availability, affordability and eventually cost. Health literacy makes it possible for the people to actively participate in the healthcare decision making process.
This webinar provides resources and guidance on effective conversations with patients and families about their goals, wishes, and values for end-of-life care.
The goal of this webinar was to educate healthcare professionals about advance directives and advance care planning,
including the types and purposes of legal documents that govern patients’ decisions and
preferences.
Dr. Elizabeth Paulk gives an excellent review of palliative care topics including end of life discussions, hospice, pain management, and family counseling.
Global health care challenges and trends_ bestyBesty Varghese
GLOBAL HEALTH CARE CHALLENGES AND TRENDS: Analyses the global healthcare trends and challenges.
Healthcare providers have a unique window of opportunity to embrace efficient new technologies that directly support better healthcare and patient experiences at a lower cost.
New healthcare systems will be:
Evidence- and prevention-based
Interdisciplinary and coordinated
Transparent, accessible, accurate, and understandable
Focused on improving patient outcomes and experience
Based on partnerships among stakeholders
Visionary in their long-term thinking
And in total International health + Global public health + Collective health + Global health diplomacy = LIFE’S RIGHT.
Start the Discussion: The Importance of Advance DirectivesSummit Health
We will discuss the importance of planning ahead about end-of-life decisions, provide useful information about how to prepare advance directives, and distribute sample forms.
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
Keynote address by Anna Dixon (Chief Executive, Centre for Ageing Better) at the Royal College of Occupational Therapists Older People Annual Conference 2017.
Geriatric Population. Geriatric Palliative and End-of-Life Care.Michelle Peck
During your journey through this slide deck Geriatric Population. Geriatric Palliative and End-of-Life Care you will experience what it means to die badly.
After practicing as a Geriatric Clinician for over a decade what I know for sure is: Life is a tremendous gift. 100% of us are going to die. If you don't communicate your end-of-life plan, then you should plan on dying badly.
In The Cost of Dying: End-of-Life Care on CBS 60 minutes Steve Kroft interviews Doctor Ira R. Byock. “Families cannot imagine that there could be anything worse than their loved one dying, but in fact there are things worse, generally it’s having someone you love die badly.” ~Doctor Ira Byock
“Dr. Byock what do you mean dying badly?” ~Mr. Kroft
“Dying suffering, dying connected to machines, denial of death at some point becomes a delusion and we start acting in ways that make no sense whatsoever.” ~Doctor Ira Byock
A majority of Americans say they want to die at home. Why is this not happening?
Place of death should be regarded as an essential goal in end-of-life care.
Let’s explore how the end-of-life decision occurs?
For Doctors
Bernacki & Block (2014) found in their review and synthesis of best practices that physician attitudes, training, and perceptions of feeling inadequate in managing the emotional and behavioral reactions of patients all play a role. A majority of trainees were not taught how to communicate and they express strong desires to learn more. Physician barriers also include not addressing psychosocial concerns, placing focus on diagnoses, treatments, and procedures during discussions about the medical care at the end-of-life.
For Patients
Bernacki & Block (2014) found that patients who do bring up dying concerns with their physicians often meet barriers and often are not aware that they are at the end-of-life. Patients that have not set goals based on meaningful conversations about their desires may overuse life-prolonging treatment and underuse services that support quality of life.
Conclusion
Bernacki & Block (2014) found that there is a large body of evidence demonstrating that early discussions of serious illness care goals are associated with:
♛ beneficial outcomes for patients,
♛ no harmful adverse effects, and
♛ potential cost savings.
Apply & Do
To prevent dying badly start early conversations, enhance your knowledge and establish goals. Dreams are only dreams until you write them down. When you write dreams down then they become goals.
Do ♛ The Conversation Project a collaboration with the Institute for Healthcare Improvement. http://theconversationproject.org/starter-kit/intro/
Do your conversation kit now and make your loved ones aware of your wishes.
Wishing you the very best, Michelle
Bernacki RE, Block SD, for the American College of Physicians High Value Care Task Force. Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices. JAMA Intern Med. 2014;174(12):1994-2003.
Health literacy is the most important factor in getting the proper health information and health services. Health literacy significantly affects healthcare accessibility, availability, affordability and eventually cost. Health literacy makes it possible for the people to actively participate in the healthcare decision making process.
This webinar provides resources and guidance on effective conversations with patients and families about their goals, wishes, and values for end-of-life care.
The goal of this webinar was to educate healthcare professionals about advance directives and advance care planning,
including the types and purposes of legal documents that govern patients’ decisions and
preferences.
Advance Directives and Advance Care Planning: Ensuring Patient Voices Are HeardVITASAuthor
GOAL: To educate healthcare professionals about advance directives and advance care planning, including the types and purposes of legal documents that govern patients’ decisions and preferences. The webinar provides resources and guidance on effective conversations with patients and families about their goals, wishes, and values for end-of-life care.
The goal of this webinar was to educate healthcare professionals about advance directives and advance care planning, including the types and purposes of legal documents that govern patients’ decisions and preferences.
The goal of this webinar is to help hospice and healthcare professionals understand the history, philosophy, and practice of hospice and palliative care, including common misconceptions, typical diagnoses for hospice referrals, identification of hospice-eligible patients, reimbursement for hospice services, and the
benefits of advance care planning and early referrals.
The goal of this webinar was to help hospice and healthcare professionals understand the history, philosophy, and practice of hospice and palliative care.
The goal of this webinar was to help hospice and healthcare professionals understand the history, philosophy, and practice of hospice and palliative care.
The Value Proposition of Hospice | VITASVITASAuthor
The goal of this webinar was to help hospice and healthcare professionals discover the evidence-based benefits of hospice care, while gaining key insights on hospice eligibility guidelines, how hospice differs from other types of care, and how the Medicare Hospice Benefit helps patients facing advanced illness.
The goal of this webinar was to educate healthcare professionals about the differences between palliative and curative care while exploring the history and philosophy of the hospice movement.
When Decision-Making Is Imperative: Advance Care Planning for Busy Practice S...VITAS Healthcare
Complex, chronically ill patients present an opportunity to discuss and implement hospice and palliative care. Many elderly patients who present to the ED and other busy practice settings are hospice-eligible because of functional decline and multi-morbidity. Key tools can quickly facilitate goals-of-care (GOC) conversations, advance care planning, and hospice referrals amid time constraints and high-acuity challenges.
Peer response’s # 2Rules Please try not to make the responses s.docxdanhaley45372
Peer response’s # 2
Rules: Please try not to make the responses super lengthy, contribute one fact AND include references
HMGT 420
· Wk#3
Talar posted Jun 4, 2016 11:57 PM
Patients who have complex health needs require not only medical. But also social services and support from a variety of caregivers and providers. Facility managers who are part of care coordination could assist patient in receiving optimal care by addressing the challenges in coordinating care for these patients, and offer programmatic changes and policies that help deliver the best services to all patients.
Facility managers can come up with strategic plans based on prior data and make necessary changes based on preexisting conditions. “Patient- centered, comprehensive, coordinated, and accessible care that continuously improved through a systems-based approach to quality and safety” (AHRQ, 2012) are what’s needed to achieve the highest quality care possible in any health care facility.
Patient centered care can’t be achieved with providers only. It requires team work and collaboration among all stakeholders. To improve the quality and safety of patients, health care facility managers can work hand and hand with the coordinated team to provide a system based approach by drawing on decision-support tools, taking into account patient experience, and using population health management approach. Patient preference and needs on what aspects of care to be improved.
Respond to Talar here:
· Vanscoy, Week 3
Sarah posted Jun 5, 2016 11:07 AM
As a facility manager, and part of the care coordination team, I would look into models of care that would assist our situation. With the Affordable Care Act in place, there are accountable care organizations (ACOs), which provide models of care (“Promise,” 2013). There are many different definitions and perspectives on care coordination, but all lead to the goal of meeting patient needs and providing adequate healthcare (“Care,” 2014).
Care coordination is essential because each patient can interact with a variety of professionals each visit. For example, for a routine physical appointment, the patient could meet with the scheduling staff, medical assistants, nurses, doctors, pharmacists, and the billing staff. If each one of these member fails to coordinate as a whole, the patient could be harmed or neglected. As a care coordinator, I would be responsible for discussing an individualized care plan with each patient and ensuring that they understand their responsibilities. All barriers should be identified, such as financial, social (language), psychological, and anything that would effect the patient from following their correct plan of care and interacting with the staff (“Promise,” 2013). Another key point is to ensure the medical staff has reviewed the patient’s medical records and ensure that everyone is on the same page. These are just a few examples, because each case is different and each patient will have different needs. .
The goal of this webinar is to help hospice and healthcare professionals understand the history, philosophy and practice of hospice care and palliative care, including common myths and misconceptions, common diagnoses for hospice referrals, identification of hospice-eligible patients, reimbursement for hospice services, and the benefits of advance care planning and early referrals.
Enhancing Access, Quality, and Equity for Persons With Advanced IllnessVITASAuthor
This diverse panel examined various facets of healthcare access, equity, and inclusion as it
relates to individuals in underserved communities who are coping with advanced illness. Based on their
decades of experience in end-of-life care, as well as evidence-based data and a compelling case study
of a Filipino-American US Navy Veteran, panel members shared strategies on how to mitigate
current barriers, including ensuring patients are granted timely access to hospice and palliative
services and that appropriate levels of care are provided.
The goal of this webinar was to help hospice and healthcare professionals understand the history, philosophy, and practice of hospice and palliative care, including common misconceptions, typical diagnoses for hospice referrals, identification of hospice-eligible patients, reimbursement for hospice services, and the
benefits of advance care planning and early referrals.
Key tools can quickly facilitate goals-of-care (GOC) conversations, advance care planning, and hospice referrals amid the ED’s time constraints and high-acuity challenges.
Palliative Care vs. Curative Care - December 2023VITASAuthor
The goal of this webinar was to educate healthcare professionals about the differences between palliative and curative care while exploring the history and philosophy of the hospice movement.
The goal of this webinar is to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
Similar to Advance Directives and Advance Care Planning (20)
The goal of this webinar was to help hospice and healthcare professionals understand the ethics and application of artificial nutrition and hydration (ANH) for patients near the end of life.
Assessment and Management of Disruptive Behaviors in Persons With DementiaVITAS Healthcare
This webinar helps physicians conduct a systematic evaluation for behavioral changes
in persons with dementia. It offers approaches for developing a comprehensive care plan for
disruptive behaviors. These methods incorporate caregiver education and non-pharmacologic
interventions followed by pharmacologic management.
Pain Management in the Context of an Opioid Epidemic: Considerations and Tool...VITAS Healthcare
This presentation details how to conduct a comprehensive pain assessment, considerations when prescribing analgesics, and when opioids may be appropriate.
Understanding Pain Management and Daily Practice ManagementVITAS Healthcare
Supported by evidence-based data, this webinar helped physicians and healthcare professionals gain greater understanding of the multifaceted applications of pain management in the context of palliative hospice care.
The goal of this webinar was to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
The goal of this webinar was to educate physicians and healthcare professionals about hospice eligibility and the benefits of hospice for patients with advanced cardiac disease (ACD).
The goal of this webinar was to equip healthcare professionals with an understanding of military veterans’ unique medical, emotional, and spiritual needs as they near the end of life.
The goal of this webinar was to equip healthcare professionals with an understanding of military veterans’ unique medical, emotional, and spiritual needs as they near the end of life.
Advanced Lung Disease: Prognostication and Role of HospiceVITAS Healthcare
The goal of this webinar was to educate physicians and healthcare professionals about the medical management of advanced lung disease (ALD), the value of advance care planning (ACP) and the benefits of hospice for end-of-life patients.
The clinical case study of a patient with advanced COPD who has multiple comorbid conditions and develops sepsis provideD the backdrop for two potential clinical pathways—sepsis and post-sepsis syndrome.
Understanding Pain Management and Daily Practice ManagementVITAS Healthcare
Supported by evidence-based data, this webinar helped physicians and healthcare professionals gain greater understanding of the multifaceted applications of pain management in the context of palliative hospice care.
The goal of this webinar was to help hospice and healthcare professionals understand the ethics and application of artificial nutrition and hydration (ANH) for patients near the end of life.
Assessment and Management of Disruptive Behaviors in Persons with DementiaVITAS Healthcare
This webinar helps physicians conduct a systematic evaluation for behavioral changes in persons with dementia. It offers approaches for developing a comprehensive care plan for disruptive behaviors.
The goal of this webinar was to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay.
The goal of this webinar was to educate physicians and healthcare professionals about hospice eligibility and the benefits of hospice for patients with advanced cardiac disease (ACD).
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
2. CE Provider
Information
VITAS®
Healthcare programs in California/Connecticut/
Delaware/Illinois/Northern/Virginia/Ohio/Pennsylvania/
Washington DC/ Wisconsin are provided CE credit for their
Social Workers through VITAS Healthcare Corporation,
provider #1222, is approved as a provider for social work
continuing education by the Association of Social Work
Boards (ASWB) www.aswb.org, through the Approved
Continuing Education (ACE) program. VITAS® Healthcare
maintains responsibility for the program. ASWB Approval
Period: (06/06/18 - 06/06/21). Social Workers participating
in these courses will receive 1 clinical continuing education
clock hour. {Counselors/MFT/IMFT are not eligible in Ohio}
3. CE Provider
Information
VITAS®
Healthcare, #1222, is approved to offer social work
continuing education by the Association of Social Work
Boards (ASWB) Approved Continuing Education (ACE)
program. Organizations, not individual courses, are approved
as ACE providers. State and provincial regulatory boards
have the final authority to determine whether an individual
course may be accepted for continuing education credit.
VITAS®
Healthcare maintains responsibility for this course.
ACE provider approval period: 06/06/2018 – 06/06/2021.
Social workers completing this course receive 1.0 continuing
education credits. VITAS®
Healthcare Corporation of
California, 310 Commerce, Suite 200, Irvine, CA 92602.
Provider approved by the California Board of Registered
Nursing, Provider Number 10517, expiring 01/31/2021.
Exceptions to the above are as follows: AL: No NHAs, DE:
No NHAs, DC: No NHAs, GA: No NHAs, KS: No NHAs, NJ:
No NHAs, OH: No NHAs, PA: No NHAs, TX: No NHAs, VA:
No NHAs, WI: No NHAs and Nurses are not required – RT
only receive CE Credit in Illinois
4. Goal
To educate healthcare clinicians about
advance directives and advance care
planning, as well as serve as a support
resource for those individuals.
5. ACP Basics
Per the National Hospice and Palliative
Care Organization (NHPCO), “Advance
care planning is making decisions about
the healthcare you would want to receive
if you’re facing a medical crisis. These are
your decisions to make, regardless of
what you choose for your care, and the
decisions are based on your personal
values, preferences, and discussions with
your loved ones.”
Advance Care Planning. Retrieved from https://www.nhpco.org/patients-and-caregivers/advance-care-planning/
6. • “Many people nearing the end of life
(EOL) are not physically or cognitively
able to make their own care decisions.”
• Of people who indicate their EOL care
preferences, most choose care focused
on alleviating pain and suffering.
Institute of Medicine (IOM). (2014). Dying in America: Improving Quality and Honoring Individual
Preferences Near the End of Life. Summary. Washington, DC: The National Academies Press.
Detering, K., et. al. (2018, May) Advance care planning and advance directives. Retrieved from:
https://www.uptodate.com/contents/advance-care-planning-and-advance-directives
ACP Basics
(cont.)
7. ACP Basics
(cont.)
Detering, K., et. al. (2018, May) Advance care planning and advance directives. Retrieved from:
https://www.uptodate.com/contents/advance-care-planning-and-advance-directives
Sudore, R.L., et al. (2017) Advance care planning for adults: A consensus definition from a
multidisciplinary Delphi panel. Journal of Pain and Symptom Management, 53(5):821.
• Frequent and ongoing clinician-patient
conversations about EOL care values,
goals, and preferences are necessary to
avoid unwanted treatment.
• Clinicians bear the responsibility to
help the patient explore treatment
options and to help them formulate their
preferences based upon a risk-benefit
analysis and their own values whenever
circumstances allow.
8. ACP Basics
(cont.)
Detering, K., et. al. (2018, May) Advance care planning and advance directives. Retrieved from:
https://www.uptodate.com/contents/advance-care-planning-and-advance-directives
Sudore, R.L., et al. (2017) Advance care planning for adults: A consensus definition from a
multidisciplinary Delphi panel. Journal of Pain and Symptom Management, 53(5):821.
• ACP supports people at any age or stage
of health in understanding and sharing their
personal values, goals, and preferences
regarding future medical care.
• Discussion goals and timing vary, based on
whether the person is healthy, has mild to
moderate chronic illness, or has an
advanced life-limiting illness.
9. ACP Basics
(cont.)
• ACP requires communication between
patients, their loved ones, and their
healthcare team, and is best done with
consideration of the patient’s relationships
and culture, which will then drive specific
medical treatment decisions that can be
recorded in an advance directive (AD).
• The primary objective of ACP is to ensure
that patients receive care aligned with their
goals and values.
Detering, K., et. al. (2018, May) Advance care planning and advance directives. Retrieved from:
https://www.uptodate.com/contents/advance-care-planning-and-advance-directives
Sudore, R.L., et al. (2017) Advance care planning for adults: A consensus definition from a
multidisciplinary Delphi panel. Journal of Pain and Symptom Management, 53(5):821.
10. Improved
Outcomes
with ACP
Teno, J.M. (2007). Association between advance directives and quality of end-of-life care:
A national study. Journal of the American Geriatric Society, 55(2):189.
Silvester, W., et al. (2016). Advance care planning in Australia: what does the law say?
Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/26567895
Molloy, D.W., et al. (2000). Systematic implementation of an advance directive program
in nursing homes: A randomized controlled trial. JAMA, 283(11):1437.
• Studies show ACP conversations improve
multiple outcomes:
– Fewer hospital admissions and intensive
treatments at end of life
– Increased enrollment in hospice care
– Higher likelihood of the person dying in
the setting of their choice
– Increased satisfaction
11. Few
Individuals
Have Had
an ACP
Discussion
With Their
Physician
Kaiser Family Foundation/The Economist. (2016, March 30-May 16). Four-Country Survey of Aging and End-Of-Life Medical Care.
Eggerston, L. (2013). Doctors, patients urged to discuss advanced care plans. CMAJ, 185(13): E617–E618.
• Only 11% report having a conversation
about end-of-life care with their health
care providers.
• Only 22% of those ages 65 and older
have had a conversation with their
healthcare provider.
• Most healthcare professionals want to
talk to patients about EOL care, and yet,
the majority of clinicians:
– Are uncomfortable
– Are unprepared
– Do not engage
13. End-of-Life
Discussions
Align Care
With Patient's
Wishes and
Values
Wright, et al. (2008). Associations between end-of-life discussions, patient mental health,
medical care near death, and caregiver bereavement adjustment. JAMA, 300(14):1665-1673.
McGill Psychological Subscale* Total Yes (+ACP) No (-ACP) P value
adjusted least square means (SE) Sample
“Depressed” 7.4 (2.9) 7.3 (0.2) 7.4 (0.2) 0.79
“Nervous or worried” 6.9 (3.2) 6.5 (0.3) 7.0 (0.3) 0.19
“Sad” 7.2 (3.0) 7.3 (0.2) 7.2 (0.2) 0.79
Acceptance, preferences Total Yes No AOR (95% CI)
and planning, N (%) Sample
Accepts illness is terminal 125 (37.7) 65 (52.9) 60 (28.7) 2.19 (1.40-3.43)*
Against death in ICU 118 (35.5) 60 (48.8) 58 (27.8) 2.13 (1.35-3.37)*
Completed DNR order 134 (41.1) 75 (63.0) 59 (28.5) 3.12 (1.98-4.90)*
Completed living will, durable 181 (55.2) 86 (71.7) 95 (46.1) 1.96 (1.25-3.07)**
power of attorney, or health
care proxy
*Subscales of the McGill Quality-of-Life Questionnaire (scale 0-10) where 0 is undesirable and 10 is desirable.
N = 322 *P value < 0.001 **P value = 0.003
14. End-of-Life
Discussions
Align Care
With Patient's
Wishes and
Values (cont.)
End-of-Life Discussions:
– 2x as likely to accept advanced diagnosis
– 2x as likely to be opposed to death in ICU
– 3x as likely to complete DNR
– Almost 2x as likely to complete a power
of attorney
– Give control back to patients and offer hope.
– Are not associated with physiological
distress compared to those who do not have
end of life discussions.
Wright, et al. (2008). Associations between end-of-life discussions, patient mental health,
medical care near death, and caregiver bereavement adjustment. JAMA, 300(14):1665-1673.
15. History of
Advance
Directives
• The advance directive is a product of the
patient and consumer rights movements
of the 1960s and 1970s, when the U.S.
Supreme Court established that patients
have a constitutional right to refuse
life-sustaining treatment – the right
of refusal.
• Over time, the Court decided that
withdrawal of care was tantamount to
refusal and extended these rights to
patients without decisional capacity
through their health care surrogates.
16. History of
Advance
Directives:
Patient
Self-
Determination
Act
Omnibus Budget Reconciliation Act of 1990. (1990). Public Law No. 101-508, §4206 & 4751.
• In 1990, Congress passed the Patient Self-
Determination Act (PSDA) incentivizing hospitals,
nursing facilities, hospices, and health maintenance
organizations to implement programs that provide all
adult patients, at the time of admission or enrollment,
with information about their rights under state laws
regarding healthcare decision-making.
• As part of the PSDA, institutions must inform
patients of the right to:
– Participate in and direct their own
healthcare decisions
– Refuse medical or surgical treatment
– Prepare an advance directive
– Review information on the institutional policies
governing these rights
17. Legal Case:
Karen Ann
Quinlan
First “right-to-die” case in U.S. legal history
April 14, 1975
• 21 year-old Quinlan stopped breathing and lapsed
into a coma
5 months later – September 12, 1975
• Was diagnosed as being in a persistent
vegetative state
• Parents requested to be disconnected from ventilator
• Doctors and county prosecutor refused to disconnect
from machines and parents took case to court
10 years later – June 11, 1985
• Weaned from respirator she survived nearly
10 more years
• Died of pulmonary failure in a nursing home
18. Legal Case:
Nancy Cruzan
Congress passed the Patient Self-Determination
Act (1990) in response to Cruzan’s case
January 11, 1983
• At 25 years old, Cruzan was in a car accident in
Missouri and was thrown from the car
• Paramedics resuscitated her
• A feeding tube was inserted after 3 weeks
in a coma
Almost 5 years later – October 23, 1987
• Cruzan’s parents requested that they be allowed to
remove feeding tube
19. Almost 6 years later – 1988
• July 27 – Cruzan’s parents were
authorized to request the withholding of food
and water
• November 16 – Missouri State Supreme Court
overturned the decision.
• Appealed the U.S. Supreme Court
8 years later – December 26, 1990
• County court ruling allowed Cruzan’s parents to
remove the feeding tube.
• Cruzan died 11 days later – 8 years after
her car accident
Legal Case:
Nancy Cruzan
(cont.)
20. Legal Case:
Terri Schiavo
The case of Terri Schiavo became subject of
intense public debate and activism
• February 25, 1990
• 26-year-old Terri collapsed at home and was
rushed to the hospital
• Four months later, Michael Schiavo, Terri’s husband,
was appointed her plenary guardian
• 8 years later – May 1998
• Michael Schiavo filed a petition to
withdraw life support
• Terri’s parents opposed, and court appointed a new
guardian ad litem (third party during custody disputes)
21. Legal Case:
Terri Schiavo
(cont.)
10-15 years later – 2000-2005
• 2000 - Given lack of living will, a trial was held to
determine what Terri’s wishes would have been.
• 2001 - Terri’s parents filed a motion filing new
evidence of Terri’s wishes and claiming new medical
treatment available.
• 2003 - Feeding tube was removed for second time.
A week later Florida legislature passed “Terri’s Law,
ordering feeding tube to be reinserted.
• 2004 - Florida Supreme Court overturned the law as
unconstitutional.
• 2005 - March 18 - Terri’s feeding tube was removed
for the third and final time.
• 2005 - March 31 - Terri died.
22. Advance
Directives
Defined
Advance directives are legal documents that
allow patients to formally state their choices
regarding what actions should be taken or
not taken regarding their health in case they
are no longer able to make decisions for
themselves because of lack of capacity
(lack of ability to make informed medical
decisions).
23. Only 1/3 of
Americans
Have an
Advanced
Directive
Yadav, K.N., et al. (2017). One in three U.S. adults completes any type of advance
directive for end-of-life care. Health Affairs, 36(7):1244-1251.
A 2017 study looked at data from more
than 795,000 Americans:
– Only 29% percent had completed a
living will that contained specific
end-of-life care wishes
– Only 33% percent had designated a
health care power of attorney
24. Do Advance
Directives
Work?
Silveira, M.J., et al. (2010). Advance directives and outcomes of surrogate decision making before death.
New England Journal of Medicine, 362:1211-1218.
* Percentages are weighted and were derived with the use of sampling weighs from the Health and Retirement Study.
DPAHC denotes durable power of attorney for health care.
Table 3. Key Outcomes According to Advance-Directive Status among 999 Subjects.*
Outcome Living Will No Living Will
(N=44) (N=552)
% of subjects
Adjusted Odds
Ratio (95% CI)
DPAHC No DPAH
(N=589) (N=407)
% of subjects
Adjusted Odds
Ratio (95% CI)
Death in a hospital 38.8 50.4 0.71 (0.47–1.07) 38.2 55.8 0.72 (0.55–0.93)
All care possible 8.1 27.7 0.33 (0.19–0.56) 13.4 27.0 0.54 (0.34–0.86)
Limited care 80.6 66.0 1.79 (1.28–2.50) 75.4 68.1 1.18 (0.75–1.85)
Comfort care 96.8 91.3 2.59 (1.06–6.31) 95.9 90.6 2.01 (0.89–4.52)
25. Importance
of Completing
Advance
Directives
Thomson Reuters. National survey of healthcare consumer: End-of-life care. Retrieved from:
http://www.factsforhealthcare.com/pressroom/NPR_report_EndofLifeCare0710.pdf
Yadav, K.N., et al. (2017). Approximately one in three U.S. adults completes any type of
advance directive for end-of-life care. Health Affairs, 36(7):1244-1251.
• Approximately 85% of adults believe that
completing an advance directive is the right
thing to do.
• 38% of patients with chronic illnesses had
completed advance directives vs. 33%
for healthy adults.
• We think it’s important, but we don’t do it.
26. Education
About EOL
Topics and
ACP Is
Needed
Fulmer, T., et al. (2018). Physicians' views on ACP and end-of-life conversations. Journal of the American Geriatrics Society. 1-5.
Figure 1. Responses to question: In your
own opinion, how important is it that
healthcare providers have advance care
planning conversations with patients?
Figure 2. Percentage of respondents who
support the new Medicare benefit paying
for advance care planning conversations.
Somewhat
important,
10% Not too/not
at all
important,
1%
Extremely
important,
51%
Very
important,
38%
Somewhat
oppose, 3%
Strongly
oppose, 1%
Supports,
95%Strongly
support, 66%
Somewhat
support ,
29%
27. Types of
Advance
Directives
• Vary depending on state law and individual
preferences within the state’s legal
requirements
• Most common types of advance directives:
– Living Will
– Durable Power of Attorney for
Healthcare/Medical Power of Attorney
28. Living Wills
• Specifies future healthcare decisions when
a patient becomes unable to express their
wishes or make informed decisions about
their healthcare
• Must also have an advanced illness or be
permanently unconscious
• Describes the type of medical treatment the
person would want or would not want
• Identifies a legal representative (sometimes
called a “surrogate” or “medical proxy”)
and provides general guidance about
what treatment an individual would or
would not want.
29. Living Wills
(cont.)
• Can range from general to specific wishes
• A legal document, not a medical order
• A competent person may revoke a living will
• Can be changed or revoked at any time if
the patient is able to communicate and is
legally competent
• Because it is not a medical order, it is
not used to treat a patient in an
emergency situation.
30. Durable
Power of
Attorney for
Healthcare
Peeler, T. (2019, October 10). Types of advance medical directives. LegalMatch. Retrieved from:
https://www.legalmatch.com/law-library/article/types-of-advance-medical-directives.html
• Legal document in which a patient names a
person to be their proxy (agent) to make all
healthcare decisions if they become unable
to do so (lacks capacity)
• Usually part of an Advance Directive, but may
be separate, as can be broader than only
healthcare decisions.
• The document may also be called a medical
(or healthcare) power of attorney (MPOA),
medical proxy, or healthcare agent.
• Almost all states require proxy designation to
be in writing.
• Proxy can be whomever the patient chooses.
• Proxy should be someone the patient trusts.
• Advisable to name a back-up
31. Durable
Power of
Attorney for
Healthcare
(cont.)
Peeler, T. (2019, October 10). Types of advance medical directives. LegalMatch. Retrieved from:
https://www.legalmatch.com/law-library/article/types-of-advance-medical-directives.html
• Proxy can speak with caregivers and make
decisions based on directions given earlier.
• If the patient’s wishes are unknown, the
proxy will decide based on what he/she
thinks the patient would want .
• If the agent does not know the patient’s
wishes, the agent must make the decision
according to the agent’s assessment of the
patient’s best interests.
• Proxy cannot be a physician or nurse
providing professional care to the patient
unless a close relative.
32. POLST/MOL
ST Forms
American College of Physicians. (2015). Advanced care planning implementation for practices. ACPOnline. Retrieved from:
https://www.acponline.org/system/files/documents/running_practice/payment_coding/medicare/advance_care_planning_toolkit.pdf
• The Physician/Medical Orders for Life-
Sustaining Treatment POLST/MOLST
summarizes the patient’s wishes in the form
of medical orders that specify the specific
medical treatments a patient wants during
a medical emergency.
• These are not advance directives, because
they contain actionable medical orders that
are effective immediately based on a
patient's current medical condition.
33. POLST/MOL
ST Forms
vs. Advance
Directives
• POLST/MOLST would be used with a
Living Will/Advance Directive to guide
clinicians if the patient is unable to make
their own decision.
• POLST/MOLST forms are intended for
individuals with a serious illness or near
the end-of-life.
• They do not name a surrogate or
medical proxy.
34. Important
Factors to
Consider
• Choosing not to have certain life-sustaining
or aggressive medical treatment is different
from refusing all medical care
• Patients may revoke a living will at
any time.
• No general agreement exists for recognizing
living wills from other states.
• A living will is much more limited than a
healthcare power of attorney.
35. • Advance directives become legally valid
as soon as they are signed in front of the
required witnesses.
• They do not go into effect unless the patient
is unable to make his/her own decisions.
• Use approved, state-specific documents.
• Changes to an advance directive should
be recorded and given to appropriate
healthcare clinicians and proxy.
• Re-evaluate yearly and as needed,
recording any changes.
Please
Remember…
36. Do Not
Resuscitate
(DNR)
Orders
• Resuscitation is an attempt by medical staff
to restart the patient’s heart and breathing.
• This may include chest compressions,
shock, and breathing machines (ventilators).
• A Do Not Resuscitate (DNR) order means
that if the patient stops breathing or their
heart stops beating, a natural death will
be allowed to happen.
• This applies in the hospital/acute care
setting.
• Some states and hospitals require a
new DNR order each time the patient
is admitted.
37. Out-of-
Hospital
(OOH) DNR
• An out-of-hospital DNR (OOH DNR)
is used when a person does not want
to be resuscitated if they are outside of
a hospital.
• Without a physician-signed OOH
DNR order or MOLST/POLST,
emergency crews must perform CPR.
• OOH DNR (like POLST/MOLST) stays
with the patient.
• OOH DNR forms and rules are
state-specific.
38. Completing
Advance
Directives Five Wishes includes a living will and a healthcare
surrogate (proxy) designation.
Five Wishes meets the legal requirements for
an advance directive in 42 states and the District
of Columbia.
For more information visit: Aging with Dignity,
www.AgingWithDignity.org, 888.594.7437
39. Five
Wishes
Wish 1: The Person I Want to Make Care
Decisions for Me When I Can't
Wish 2: The Kind of Medical Treatment
I Want or Don't Want
Wish 3: How Comfortable I Want to Be
Wish 4: How I Want People to Treat Me
Wish 5: What I Want My Loved Ones
to Know
40. What to
Do With
Advance
Directives
• Provide a copy to the proxy, backup,
clinicians, attorney, and other
trusted people.
• Keep original safe but easily accessible.
• Recommend to keep a card in their purse
or wallet that states that they have an
advance directive and where it is located.
41. Advance
Directives
and Hospice
• Patients are not required to have advance
directives or an OOH DNR in order to
receive hospice care.
• Hospice staff will discuss the importance
of advance directives in preserving
patient choice.
• Hospice offers training on advance
directives.
42. Starting the
Conversation
• Take the initiative
• Take responsibility
• Take a closer look at dying
• Listen more than you talk
• Find out what is important to the patient
• Learn the patient's underlying values and goals
• Tie the discussion to relatable experiences
• Include discussion about faith
• Allow yourself to not know all the answers
• Allow the patient and family to not know all the
answers
• Allow for silence and time to think
43. Taking the
Initiative
Abdelmalek, C., Goyal, S., Narula, A., Paulino, R., & Thomas-Hemak, L. (2013).
Advance directives: Give teeth to end-of-life choices. Aging Well, 6(1), 24-27.
• ACP is a recurring conversation
about the patient’s goals, values, and
treatment preferences
• Include DPOA in the ACP conversations
• Accommodate diverse belief systems
• Conduct ACP when the patient is
mentally and emotionally healthy
whenever possible
44. SPIKES
Buckman, R., and Kason, Y. (1992). How to break bad news: A guide for health care professionals.
Baltimore: The Johns Hopkins University Press
• S = Setting. Choose a private setting where you can
sit with the patient and a family member
or confidant. Plan ahead. Know the patient and situation.
• P = Perception. Ask the patient what they have been
told/understand before sharing information with them.
• I = Invitation. Ask permission to share your knowledge of the
situation – how much do they want to know about their disease,
tests, treatments, prognosis, etc. Give permission for them to
stop or pause the conversation if needed.
• K = Knowledge. Share information clearly and compassionately.
Avoid jargon. Share information, then stop talking. Listen.
• E = Emotion/Empathy. Convey empathy with body language
and words. Allow for emotion, and offer support statements
(“I’m sorry we are having this conversation,” “it’s okay to be
upset.” Don’t say “I understand what you’re going through.”
• S = Summary. Summarize the conversation. Plan for next
visit/conversation.
45. Something
to Consider
It is difficult to have an
end-of-life discussion through
an ET tube.
—Mark Reid, MD
@medicalaxioms
47. ACP Services
Reimbursement
CPT Code 99497
• Advance care planning including the
explanation and discussion of advance
directives such as standard forms
(with completion of such forms, when
performed) by the physician or other
qualified healthcare professional
• First 30 minutes of the day, face-to-face
with the patient, family member(s)
and/or surrogate
CPT Code 99498
• Each additional 30 minutes (list separately
in addition to code for primary procedure)
• May have multiple in a day
48. Closing
Thought
I have an advance directive, not
because I have a serious illness,
but because I have a family.
—Ira Byock, MD
50. References
• Abdelmalek, C., Goyal, S., Narula, A., Paulino, R., & Thomas-Hemak,
L. (2013). Advance directives: Give teeth to end-of-life choices.
Aging Well, 6(1), 24-27.
• Advance Care Planning. Retrieved from:
https://www.nhpco.org/patients-and-caregivers/advance-care-planning/
• American College of Physicians. (2015). Advanced care planning
implementation for practices. ACPOnline. Retrieved from:
https://www.acponline.org/system/files/documents/running_
practice/payment_coding/medicare/advance_care_planning_
toolkit.pdf
• Buckman, R., and Kason, Y. (1992). How to break bad news:
A guide for health care professionals. Baltimore: The Johns
Hopkins University Press.
• Detering, K., et. al. (2018, May) Advance care planning and
advance directives. Retrieved from:
https://www.uptodate.com/contents/advance-care-planning-and-
advance-directives
• Eggerston, L. (2013). Doctors, patients urged to discuss advanced
care plans. CMAJ, 185(13): E617–E618.
51. References
• Fulmer, T., et al. (2018). Physicians' views on ACP and end-of-life
conversations. Journal of the American Geriatric Society. 1-5
• Institute of Medicine (IOM). (2014). Dying in America: Improving Quality
and Honoring Individual Preferences Near the End of Life. Summary.
Washington, DC: The National Academies Press.
• Kaiser Family Foundation/The Economist. (2016, March 30-May 16).
Four-Country Survey of Aging and End-of-Life Medical Care.
• Molloy, D.W., et al. (2000). Systematic implementation of an advance
directive program in nursing homes: A randomized controlled trial.
JAMA, 283(11):1437.
• Omnibus Budget Reconciliation Act of 1990. (1990). Public Law No.
101-508, §4206 & 4751.
• Peeler, T. (2019, October 10). Types of advance medical directives.
LegalMatch. Retrieved from: https://www.legalmatch.com/law-
library/article/types-of-advance-medical-directives.html
• Silveira, M.J., et al. (2010). Advance directives and outcomes of
surrogate decision making before death. New England Journal of
Medicine, 362:1211-1218.
52. References
• Silvester, W., et al. (2016). Advance care planning in Australia: what
does the law say? Retrieved from:
https://www.ncbi.nlm.nih.gov/pubmed/26567895
• Sudore, R.L., et al. (2017) Advance care planning for adults: A
consensus definition from a multidisciplinary Delphi panel. Journal of
Pain and Symptom Management, 53(5):821.
• Teno, J.M. (2007). Association between advance directives and quality
of end-of-life care: A national study. Journal of the American Geriatric
Society, 55(2):189.
• Thomson Reuters. National survey of healthcare consumer: End-of-life
care. Retrieved from:
http://www.factsforhealthcare.com/pressroom/NPR_report_EndofLifeCar
e0710.pdf
• Wright, et al. (2008). Associations between end-of-life discussions,
patient mental health, medical care near death, and caregiver
bereavement adjustment. JAMA, 300(14):1665-1673.
• Yadav, K.N., et al. (2017). one in three U.S. adults completes any type
of advance directive for end-of-life care. Health Affairs, 36(7):1244-1251.