Starting the conversation about end-of-life care
Daren Heyland’s work bringing the importance of end-of-life planning to the attention of Canadians has been fundamental in establishing today’s inaugural National Advance Care Planning Day.
“Productive advance care planning involves a physician interacting with a patient and his or her family, disclosing a prognosis, and discussing various options and preferences,” explains Dr. Heyland, a professor of Medicine at Queen’s and the director of the Clinical Evaluation Research Unit at Kingston General Hospital. “In the elderly or seriously ill populations that we’ve been studying for over a decade, less than 18 per cent have a prognostic disclosure, meaning that the vast majority of these individuals haven’t been told that they are near the end of life.”
For Dr. Heyland, a lack of awareness and effective communication is the real barrier to having good advance care planning systems. Canadians often aren’t aware that the care they might require in their final days is an important consideration and are rarely encouraged to engage in thinking and talking about the issue by their health care professionals. Effective advance care planning requires that patients and their families are supported in making end-of-life care decisions and they are able to communicate those choices to their physicians.
“This is why the campaign is called ‘Speak Up’— it’s about starting the conversation about end-of-life care and is aimed at lay people, patients and healthcare professionals,” says Dr. Heyland. “It’s so important for people to define their wishes to their loved ones. The tragedy is that when it becomes vital to have these conversations, patients are usually too sick to participate. That places a heavy burden of decision-making on family members, which can be an extremely stressful experience.”
Dr. Heyland’s most recent research, the ACCEPT study, received funding from the Canadian Institutes of Health Research and is designed to evaluate the effectiveness of advance care planning strategies that have already been implemented in Canada.