Introduction
Medicine is one of the industries that are always in demand and constantly goes through significant advancements. However, when talking about the development of effective treatments and delivering the best quality care to the patients, many professionals tend to forget about the importance of effective communication. Doctors and nurses focus on choosing the most appropriate medical drugs and completing necessary diagnostic tests but do not pay attention to the relationships they develop with individuals. It can be stated that successful communication within Advance Care Planning is vital for ensuring a person’s personal needs and preferences are satisfied and the goals are achieved (Jimenez et al., 2018). At the same time, keeping trustful relationships with the patients and interacting with them and their relatives can also be challenging from an emotional point of view (Carter, Detering, Silvester, & Sutton, 2016). On the examples of Dorothy’s case, it is visible what issues can arise and how they affect sick people, their families, and their healthcare providers. Therefore, the following paper will discuss various barriers that impede communication within Advance Care Planning and explore what communication skills can promote a more effective conversation.
Overview of Dorothy’s Case
Dorothy is an elderly woman who suffers from a variety of severe health conditions that need constant and expensive treatment. Dorothy is in her 70s and has ovarian cancer that she has been dealing with for a long period of time already. Unfortunately, the cancer treatment did not appear to be effective enough which made the disease spread to other areas of her body. In addition to this serious health problem, the woman experiences some other issues that are generally caused by her age. Therefore, Dorothy is in need of continual medical care and support from her relatives and friends.
Furthermore, the woman does not only go through physical pain and suffering but also experiences some emotional challenges at the moment. Her loving husband died from cancer four months ago, and this event influenced Dorothy’s view on the problem and her expectations from the treatment. In addition, her sister also died from the same condition that Dorothy has. The fact that the woman saw how her sister went through the treatment and surgery and analyzed the negative influences of medical manipulations on her body put her in a more challenging situation emotionally. Her sister’s experience has also influenced her decision of whether she wants to surgically remove the tumor or not. Since it led to the worsening of the sister’s condition, Dorothy became skeptical about it. Dorothy saw how the people she loved and cared for died; thus, she losses her hope to recover and get back to normal life.
Moreover, the women’s health condition and the death of her husband have a huge influence on the mental health of their children. They had to witness how both parents experienced severe physical pain and dealt with the understanding that they are going to die soon. For this reason, children try to be as supportive of Dorothy as possible and deliver constant care to her. Dorothy herself mentioned that in addition to the support of her children, nurses’ help was important when she stayed at the hospital. Their ability to establish a trustful relationship and openly communicate with their patients made Dorothy less afraid of sharing her concerns about health and talk about the perspectives of treatment and possible death (Sudore et al., 2017). Thus, the ability to engage in open interactions with medical specialists helped Dorothy to make appropriate decisions about her future care and prepare for the outcomes of the treatment process.
Overview of Advance Care Planning
Before discussing Advance Care Planning on the example of Dorothy and connecting it to other concepts, it is first necessary to explain this process and its characteristics. As mentioned by Scott, Mitchell, Reymond, and Daly (2013), Advance Care Planning is a specific procedure of making choices concerning future treatment decisions and care practices in collaboration with physicians, nurses, and family members. One of the most essential goals of this process is to safeguard medical decisions in case a patient loses their ability to communicate, express their preferences, or make choices (Scott et al., 2013). Even though the concept of Advance Care Planning existed for decades, its acceptance and implementation have not been very common, and individuals started to pay attention to it only in recent years (Sellars et al., 2017). At the moment, medical specialists have come to an understanding that the idea of Advance Care Planning is extremely beneficial since it allows people to “live out the final stage of life as fully as possible” (Thomas, Lobo, & Detering, 2017, p. 5). Hence, this concept is vital when it comes to ensuring a positive experience for seriously sick individuals.
It is necessary to mention that Advance Care Planning can have a positive influence not only on the patients but also on their relatives and loved ones. As indicated by Thomas et al. (2017), open conversations that happen with healthcare providers during the stage of advance care encourage individuals to look at their life from a broader perspective. This strategy can give people the possibility to have a positive mindset and hope for the best while, at the same time, preparing for the worst outcomes (Bollig, Gjengedal, & Rosland, 2016). This phenomenon, in return, has a beneficial influence on the family and friends of sick individuals. When human beings understand that their close people’s needs and preferences were met and their wishes were known, they feel safer about the next steps and the results of the treatment in general (Rietjens et al., 2017). Consequently, Advance Care Planning can be referred to as a critical process that contributes to the satisfaction of both patients and their caretakers.
Analysis of Advance Care Planning
Even though Advance Care Planning itself is a beneficial process, some preconditions determine its success. Gilissen et al. (2017) suggest that there is a specific number of elements that decide whether the implementation of the plan will be effective or detrimental for the patient. These components include the existence of appropriate knowledge and skills, positive relationships, the ability and motivation to participate in care planning, and an effective administrative system (Gillisen et al., 2017). By taking a look at Dorothy’s example and the information that she provided in the interview, it can be stated that some of these elements were in place during her treatment. She was able to establish good relationships with her doctors and nurses that had an enormous amount of professional experience and knowledge. In addition, the woman and her family had a desire to impact her treatment journey and make it less emotionally challenging.
As mentioned earlier, Advance Care Planning is especially helpful for individuals who cannot make important medical decisions themselves due to specific health conditions that limit their ability to communicate or engage in the thinking process. During ACP, patients express their needs and desires to ensure all preferences are met should they have challenges interacting in the future (Martin, Hayes, Gregorevic, & Lim, 2016). Nurses play a significant role during this procedure as they inform patients about their rights and different ways that can bring modifications to their treatment (Ke, Huang, O’Connor, Lee, 2015). During the interview, Dorothy mentioned that she found that the process of ACP was very beneficial for her. Even though the woman did not lose her capacity to communicate, the support of nurses helped her to accept her health conditions and make some important decisions.
It is also concluded that ACP is especially effective for elderly individuals who suffer from serious health issues. While the concept can be used to treat all age groups, old adults are the ones who are influenced by the process the most (Weathers et al., 2016). Since elderly individuals are usually more vulnerable than young people, it is important for them to feel the support of the healthcare providers and understand that they are in control of their well-being and treatment (Dixon, Matosevic, & Knapp, 2015). Therefore, being in constant contact with doctors and nursing specialists, helped Dorothy to feel that she will be cared for properly in case she loses her capacity to make decisions.
Medical Treatment Decision Makers
In addition to engaging in constant communication and giving patients freedom to express their opinion about future care, medical treatment decision-makers have to be confident and educated enough to control the situation. Considering the vulnerability of sick individuals “clinicians, healthcare teams, and other stakeholders when working with their patients must be diligent when formulating treatments decisions” (Farrel et al., 2017, p. 14). In this case, medical professionals can ensure that their patients will not experience any negative feelings or feel depressed due to the undesirable outcomes of the treatment.
Furthermore, medical treatment decision-makers have to be not only experienced and educated but also able to listen to the desires of their patients. Specialists have to understand the personalities of sick individuals, their backgrounds, and the reasons why they make specific healthcare decisions (Hurwitz et al., 2016). This strategy allows doctors and nurses to obtain necessary information about their patients and use certain communication techniques with them that match their distinguishing features and opinions (Orom, Biddle, Underwood III, Nelson, & Homish, 2016). Therefore, Advance Care Planning should be used in collaboration with effective interactive strategies that promote trustful relationships.
Advance Care Directives
Advance Care Directives are an important part of end-life care as they formalize the final version of ACP. Decretive contains all the values, goals, and desires of the patient should they lose their capacity to communicate and make decisions (Luckett et al., 2015). Since these documents define patients as the primary persons who have a right to make choices regarding their future, it is essential to ensure open and transparent communication at the stage of establishing a directive (Zivkovic, 2018). This strategy will give medical institutions a chance to make their contributions to the decision-making process of individuals and lead them in the right direction.
Having an Advance Care Directive is essential since it ensures that all the desires are properly documented and followed by the medical facility. When the needs and preferences are communicated just verbally, it may be hard to keep track of them and make sure that all the practices are implemented (Sellars, Detering, & Silvester, 2015). For this reason, all people who are more than 18 and have a specific decision-making capacity can make official choices regarding financial, healthcare, and personal matters (Johnson, Singer, Masso, Sellars, & Silvester, 2015). By clearly stating their Advance Care Directives, individuals can make sure that they are taken seriously and followed by the medical staff of the facility that delivers treatment to them. In general, Advance Care Directives are an essential component when it comes to end-life care because they play a significant role in establishing official and transparent communication with hospitals and other healthcare centers.
Conclusion
To summarize, Advance Care Planning is an essential concept that ensures the delivery of proper care in case patients lose their capacity to communicate or make important healthcare decisions. On the example of Dorothy’s case, it can be seen how effective Advance Care Planning helped the patient to focus on the positive, hope for the best, and accept the most negative result of her treatments. I also helped her to cope with the death of her husband and sister and analyze the positive and negative effects of their treatment. In addition, the process helped her to establish strong relationships with nurses and doctors and share her concerns and desires for the future.
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