Advance Care Planning with BJ Miller and Rebecca Sudore
Our podcast is hosted on Spotify and Anchor.
BJ Miller, Mettle Health founder, palliative care and hospice physician and author, and Rebecca Sudore, geriatrician and palliative medicine physician, host an informal and interactive conversation on advance care planning conversations and related documents.
Advance care documents are tricky to complete if you don't understand the context or consequences of the medical decisions you are asked to make. What is a health care proxy, and what does the role entail? Do you want artificial nutrition when you can no longer feed yourself? How about a ventilator? How do you feel about being in an ICU? Do you need a POLST or DNR form? In this recording we discuss:
Show Notes:
0:00 Introductions
3:48 The history of advance care planning
9:50 What are the realities of advance care planning? What works and what doesn’t? Forms vs. conversations
12:45: Evolution of “planning” in advance care planning
13:44 The important of having a conversation plus completing documents, the form is only as good as the conversation that goes with the form
16:18 Advance care planning is not a one and done process
17:15 A list of the different forms you will run into in advance care planning: POLST, DNR, Living Will and Advance Directive
21:30 POLST forms and why they were created
23:48 How to think about unexpected occurrences like accidents and advance care planning?
25:57 Difference between a POLST and a DNR
27:15 Considerations for 18 year olds and college age adults
29:43 The reality of being a proxy or advocate for someone else, it’s hard!
30:45 Where are the gaps in advance care planning? It’s not just a form, it’s many components
35:10 Prepare for your care website and resources! Step by step guidance, videos and forms
38:30 How advance directive services can partner with hospital systems to get advance directives into an electronic medical record
39:36: How to add details specific to you to an advance directive
41:44 How much do CMS requirements about advance directives drive completion?
43:31 What about advance directives for dementia or Alzheimer’s?
45:24 Does completing an advance directive help lesson tensions and distress for family members? How can it be helpful to have things in writing?
48:42 How often should people update their advance directive?
50:00 How to think about prognosis and advance directives
51:30 How to approach advance care planning discussions with aging parents?
54:16 How do people without family or friends advocate for themselves and complete documentation that honors their wishes?
55:34 Can you link to a wish for Physician Assisted Death in an advance directive?
58:24 Are general practitioners required to bring up advance care planning? How do you bring it up with your doctor?
1:01:23 How to think about saying yes or no to a ventilator? How to think about life saving treatments: finding a middle ground
01:03:45 How to think about treatments - what is the outcome from the treatment?
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