Advance Care Planning

Advance care planning is an ongoing process of talking about your goals, values and wishes in terms of your health care. You are encouraged to discuss these topics with your caregivers, friends, those who represent you, and your health care team.

It helps to have these talks with your caregivers and health care team early so that you can think through your options and identify what is most important to you. In the event that your caregiver or doctor needs to make choices when you are ill, they can do so with confidence that they are following your wishes.

How can I make my health care preferences known?

Whether you're a patient or caregiver, having conversations about your care and the future should be part of your normal routine. If you haven't had these conversations, they should start at diagnosis and be revisited through every phase of treatment. 

Here are some steps for implementing the advance care planning process:

Evaluate quality of life. Think about what quality of life means to you. Ask yourself how you want to live. What is important for you to continue being able to do throughout treatment or if you become seriously ill?

Have a conversation with your loved ones. Discuss your thoughts with the people who would be involved in making decisions for you if you aren't able to make them yourself. This will ensure that care choices support the quality of life you'd like.

Identify a loved one who can make decisions. Which person in your life do you trust to understand what quality of life means to you? Make sure this person is willing to make decisions for you if needed and that he or she knows what's important to you in your care choices. Don't assume anything.

Talk with your health care provider. Once you have defined your own terms for quality of life and identified someone to carry out your wishes, review all of it with your health care provider. Doing so will inform your doctor about what treatment options you would or wouldn't want down the road, and allows your doctor to provide medical input and perspective. 

Complete the paperwork. Completing advance directives is one way for you to make your wishes known about medical treatment before you need such care. There are three kinds of advance directives in Texas:

Medical Power of Attorney: This form allows you to appoint someone you trust to make health care choices for you if you are unable to do so for yourself.

Living Will: This form allows you to tell people what kind of medical care you would like to have or avoid if you cannot speak for yourself.

Out-of-Hospital Do Not Resuscitate (OOHDNR) Order for Adults: An order signed by a doctor allowing you to refuse life-sustaining treatments when outside the hospital. If you are admitted to the hospital and do not wish to have life-sustaining treatments, let your doctor know so an inpatient DNR order can be signed for the duration of your stay. 

In collaboration with their physicians, some people decide they do not want CPR either because it is unlikely to work or because it does not fit with their care goals. If you decide that either type of DNR order is right for you, it is important to remember that all efforts directed at your comfort will always continue, as will all other medical care that you and your doctor think is appropriate. 

Speak with your Social Work Counselor about other advance care planning documents you might want to consider:

• Durable power of attorney
• Appointment for disposition of remains
  
• Organ donation

You do not need a lawyer to complete these forms. Once completed, you will be asked for a copy to include in your medical record so that your wishes can be communicated to the medical team.

The Department of Social Work also has an advance care planning workbook that will guide you through the process, and help you think through the types of care you would like to receive at every stage of your treatment. 

Adjust as your medical condition changes. Advance care planning is an ongoing process. You can always change your mind and re-evaluate your treatment goals as needed.

To learn more about advance directives, the advance care planning process or to speak with someone about end-of-life concerns, contact the Department of Social Work at 713-792-6195, or tell your nurse or doctor that you'd like to speak with a social work counselor.