Table 2 What PCPs want patients/family members to know or come back having done
Categories | Illustrative Quotes |
|---|---|
Greater knowledge and understanding of ACP | “Clear understanding and awareness of ACP” “What some of the language around ACP (advance directives, no CPR etc.) means” “Further understanding about what various MOST [Medical orders for scope of treatment] statuses actually entail” “Knowledge of various means to sustain life in hospital and their limitations” “Learn about futile care and poor outcomes after resuscitation in many people” “Understanding scenarios that require certain types of decisions - i.e. that a tube feed can be temporary after a stroke, that dialysis can be temporary and can always be stopped after being started, and conditions under which SDMs [substitute decision maker] are called on.” |
Reflections on personal wishes and self-empowerment | “Consider their values/what is most important to them, their goals of care, who their substitute decision maker might be” “Had some thoughtful assessment of their own situation” “Done some thinking about what quality of life they want for right now and what functional limitations would make life possibly not worth living in the future” “A feeling of empowerment over their health” |
Discussions with family and close friends | “Had family discussions so everyone aware of patients desires and not come back to keep discussing family differences” “Explored […] their family’s emotions around ACP” |
Readiness to continue discussion with GP | “Be willing to talk about a plan” “Feel heard + understood + safe to continue to conversation with me/team” “Have [their understanding of ACP] open the door for discussion with their physician” “Bringing back specific questions they have about their health or prognosis” “To ask primary care provider re medical conditions and prognosis/alternative treatment/care plans” |
Paperwork and legal forms | “Know about […] legal affairs to get in order” “Legal forms/discussions to appoint SDM [substitute decision maker] and POA [power of attorney]” “Understanding of [Medical Orders for Scope of Treatment] forms” “A brief card with some of the decision points - come back with it” |