Navigating serious or progressive chronic illness is stressful for patients and their loved ones. For clinicians and patients, this is a crucial time to talk.
While many with serious illnesses want to avoid tests and treatments that may cause harm, particularly at the end of life, many end up receiving them because their wishes are not known.
Choosing Wisely Canada encourages conversations between clinicians and patients with serious or progressive illnesses. Taking the time to talk can help to avoid potentially harmful or overly aggressive tests and treatments that may not align with a patient’s goals and wishes.
Clinicians agree it’s time to talk. Over 30 national clinician societies representing different specialties support the following recommendation that can encourage conversations about goals and wishes.
Don’t offer tests or treatments without establishing your patient’s prognosis, preferences, and goals of care. Potentially harmful or overly aggressive tests or treatments can be avoided by having discussions about goals and wishes, and documenting this information.
Early conversations about disease understanding, wishes, and goals with patients who have serious or progressive chronic illness can avoid potentially harmful tests or treatments. Ensuring patients discuss and document wishes and goals, as well as identify a substitute decision-maker can support evidence-informed and patient-centred care.
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.
Weathers E, O’Caoimh R, Cornally N, et al. Advance care planning: A systematic review of randomised controlled trials conducted with older adults. Maturitas 2016;91:101–109.
Detering Karen M, Hancock Andrew D, Reade Michael C, Silvester William. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial BMJ 2010; 340 :c1345
Canadian Academy of Child and Adolescent Psychiatry | Canadian Academy of Geriatric Psychiatry Canadian Association for the Study of Liver | Canadian Association of Emergency Physicians | Canadian Association of Gastroenterology | Canadian Cardiovascular Society | Canadian College of Medical Geneticists | Canadian Critical Care Society | Canadian Society of Endocrinology and Metabolism Canadian Geriatrics Society | Canadian Headache Society | Canadian Neurological Sciences Federation Canadian Neurological Society | Canadian Orthopaedic Association | Canadian Paediatric Society Canadian Psychiatric Association | Canadian Society for Vascular Surgery | Canadian Society of Allergy and Clinical Immunology | Canadian Society of Internal Medicine | Canadian Society of Palliative Care Physicians | Canadian Society of Surgical Oncology | Canadian Special Interest Group of the American Burn Association | Canadian Spine Society | Canadian Thoracic Society | Canadian Urological Association | Cell Therapy Transplant Canada | College of Family Physicians of Canada | Nurse Practitioner Association of Canada | Public Health Physicians of Canada | Canadian Society of Nephrology | Society of Obstetricians and Gynaecologists of Canada | Society of Rural Physicians of Canada
Taking the time to talk about goals and wishes is an important first step. This conversation can help inform future health care choices, including what someone may or may not want.
Expressing goals and wishes in an advance care plan can help inform what kind of health and personal care someone receives if they are unable to speak for themselves. Advance Care Planning Canada is a national initiative that provides tools for clinicians and patients to guide individuals through this process.Start a Plan