During COVID-19, help yourself and your family with advance care planning
COVID-19 has created a lot of fear and uncertainty, but for many of us, it has also created a renewed sense of community and deeper appreciation of our loved ones as we begin to recognize the fragility of life.
We are physicians and health care providers. We are working around the clock to prepare for and care for people sick with COVID-19. There has been concern about whether we will have enough equipment and staff to provide patient-centered care to everyone who needs it. We are alarmed at how patients confirmed with COVID-19 can go from being seemingly healthy one minute to seriously ill or worse in a matter of a few days. Too often, there is little or no time for the patient to communicate their personal values, or whether CPR, ventilator support or other intensive care is something they want to receive or avoid.
The concerned public asks us what they can do to support our medical providers and our state’s health care system during these incredibly difficult times. One answer is simple: plan ahead and share your voice. Beyond listening to the health experts and doing your part to reduce the spread of COVID-19, you can make a big difference by having conversations with your family about what treatments you would want, or not want, if you became seriously ill — and finding out what treatments your family members would or wouldn’t want. Some of these questions can be hard to discuss, but it will be a much more difficult conversation down the road if you or a family member falls seriously ill.
This health crisis and the need for sheltering in place have brought many families closer together, whether under one roof or by telephone or video. It sets the stage for having a thoughtful discussion about personal values, goals and wishes. Now is the time for you and your loved ones to complete a health care directive that outlines your wishes for medical treatment, and names one or more people you trust to make medical decisions for you if you can’t speak for yourself.
Even though advance directives have been promoted by health professionals for nearly 50 years — everyone 18 and over should have one — only about a third of U.S. adults have completed an advance directive, according to a 2017 study published in Health Affairs.
Individuals who are frail or have a serious or chronic illness and want to be selective about medical interventions, including CPR and ventilator support, should ask their healthcare provider about completing a POLST (Physician Orders for Life Sustaining Treatment) form. POLST is a specialized advance care planning tool that translates patient wishes into medical orders that paramedics and other medical providers can follow. The California POLST must be signed by the patient or their decision-maker and a physician, nurse practitioner or physician assistant.
What people often fear most with serious illness is the loss of control, the loss of their ability to think and speak for themselves. Completing an Advance Directive or POLST and sharing your thoughts with your family helps ensure you have a voice in the care you receive. It’s a gift you give to your family, who might otherwise agonize over treatment choices they are forced to make for you in a crisis situation. Finally, it’s a tremendous aid to the medical team, who can develop a treatment plan knowing it’s based on your values and wishes.
There are many free resources to help you get started with care planning. Excellent sites include the COVID-19 Conversations Toolbox at the Coalition for Compassionate Care of California (https://coalitionccc.org/covid-conversations-toolbox/ ). The Conversation Project.org, CaPOLST.org, Five Wishes.org, and PREPAREforYourCare.org, also have ideas to aid your discussion, with forms you can easily download and use.