For Health Care Professionals
The Plan Well planning guide was created by critical care physician and researcher Dr. Daren Heyland, who has been studying communication and decision-making for seriously ill patients for more than 20 years. He and his colleagues have conducted many research projects through the Canadian Researchers at the End of Life Network (CARENET), the results of which have been used to inform the development of this planning tool.
Why use this guide?
Decision support tools like this one have been shown to improve quality of decision-making and numerous patient outcomes, including:
• Greater satisfaction with decision-making
• Greater knowledge
• Reduced decision conflict
• Medical treatments more likely to be congruent with patient’s values
At the same time, these types of tools reduce the physician time and emotional burden of engaging their patients in these planning conversations.
A randomized trial of Plan Well Guide was recently published in CMAJ Open. The results showed that Plan Well Guide improves decisional quality, patient and physician satisfaction, and reduces time physicians spend on their interactions with patients.
To read the full article visit the e-publication, here: https://bit.ly/2W4nzLf
For a visual summary of the results of the RCT, check out the Plan Well Guide infographic, here!
What’s different about this guide?
Compared to other tools that may be used to help patients near or at the end of life, our Plan Well Guide offers the following features or attributes:
1) Discriminates between planning for terminal care vs. planning for serious illness
2) Explains how we make medical decisions under conditions of uncertainty
3) Utilizes a ‘constrained’ values clarification tool where respondents have to pick between competing values
4) Uses ‘Grids’ to transparently connect states values to respondent preferences for medical treatments during serious illness
5) provides a ‘first in class’ decision aid on the different levels of care, with explanations about the difference between ICU, Medical and Comfort care, so participants understand the risks, benefits and outcomes of the type of treatments they are preferring
How to use the website
You can use the website to help your patients better understand the different types of medical care, and what would be important to them during serious illness. They can then use the “Make a Plan” tab to document their values and preferences, and to print out a “Dear Doctor” letter that can be shared with you and their loved ones.
In general, we recommend that the attending or primary care physician engages the patient and/or substitute decision-maker to go through the website and discuss it amongst themselves, complete the ‘Make a Plan’ section, and bring that back to a subsequent appoint for discussion with the Doctor and translation of the ‘Plan’ into a medical order for the use of life-sustaining treatments.
Depending on your setting, this approach may require some adaptation. For example, if you have access to allied health care professionals or volunteers who can engage the patient and review the website with the patient and/or family, that may work better. Alternatively, if the doctor sends the patient home to review the website independently, an allied health professional or volunteer may meet with the patient before they meet with the doctor again to ensure they have gone through the website and understood the information presented.
Patient Goals of Care Designation Worksheet
This two page worksheet found here, is a quick guide to determine patient goals of care designation. It was designed as a tool for health care professionals to use with patients who are unfamiliar with Plan Well Guide. It is designed for those who haven’t been through the website or the pamphlet but who you want to use the constraining values scales and the grid to guide your conversation in the moment. It can be used when you are seeing the patient in the clinic, the ER, or on the wards, and when you don’t have the luxury of time to send them off to do their preparatory work on the Plan Well Guide website or pamphlet.
This training video demonstrates the unique features of the Plan Well Guide website and shows how it can be used in clinical practice. For more information and a live demo or presentation, please contact Dr. Daren Heyland at firstname.lastname@example.org.
Website Training Video
There are videos on this website that demonstrate conversations between physicians and patients about the different types of medical care. We have also developed a number of resources to help you share this website, and to support your patients as they reflect on their values and preferences:
Plan Well guide Prescription Pad – this downloadable prescription pad gives you a convenient way to encourage your patients to visit the Plan Well website.
Plan Well Guide (short version) – Get the medical care that’s right for you!” – this printable pamphlet is a shortened version of the key information on the website and outlines the different types of medical treatment and asks patients questions about their values and preferences. The last four pages can also act as the ‘Dear Doctor’ letter, they are a good place to record the patients values and preferences, for those who may not wish to work directly on the website.
“ACP Conversations” video – this video features families, doctors and researchers who have had advance care planning discussions and may be used to motivate patient and families from engaging in this planning exercise.
“CardioPulmonary Resuscitation (CPR)” – this video describes CPR and provides statistics around survival rates and the impact of CPR on various age groups, to help patients understand whether CPR is right for them.
Conversation Guide – This Guide provides a framework including ‘scripts’ to assist you with engaging patients and/or their substitute decision makers (in the case of an incapacitated patient) in goals of care (GOC) conversations that lead to medical orders for the use or non-use of life-sustaining treatments.
If you have comments or feedback regarding this website, please contact Dr. Daren Heyland at: email@example.com.