Healthcare Professionals

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. Our Advance Serious Illness planning tool is the best one available to date. 

Plan Well 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. Our Advance Serious Illness planning tool is the best one available to date. 

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.

People who used our advance serious illness planning tool:

  • Reported a greater sense of control over their health care,
  • Reported improved communication between them, their family members and their clinicians, and
  • Reported increased satisfaction with their medical care they receive.
  • Were much more likely to get medical care that was consistent with their values and preferences.

Also, advance medical care planning was shown to reduce the burden and conflict among loved ones and reduced stress, anxiety and depression in surviving family membersi.

[i] McMahan, Ryan D., et al. Deconstructing the Complexities of Advance Care Planning Outcomes: What Do We Know and Where Do We Go? A Scoping Review. 7 Sept. 2020, onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16801.

What's Different About This Advance Serious Illness Planning Tool

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 stated values to patient’s 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 patients understand the risks, benefits and outcomes of the type of treatments they are preferring

To learn more about the unique features of Plan Well Guide, check out our video series below, where Dr. Heyland explains the key components behind Plan Well Guide.

A randomized trial of Plan Well Guide that evaluated the impact of advance serious illness planning on substitute decision-makers was recently published in the British Medical Journal of Supportive and Palliative Care. The results suggested that amongst those who, at baseline, had the least confidence in their role, Plan Well Guide significantly increased their readiness to function in their role.

A randomized trial of Plan Well Guide was recently published in CMAJ Open. The results showed that Plan Well Guide improves decision quality, patient and physician satisfaction, and reduces time physicians spend on their interactions with patients.

How To Use This Website in Your Practice Setting

You can use this serious illness planning tool to help your patients better understand the different types of medical care and what would be important to them during serious illness. The website will generate a ‘Dear Doctor’ letter after the patient completes their plan. They will be able to share this letter with you which will help them communicate their values and preferences for medical care and any outstanding questions they may have.

In general, we recommend that the attending or primary care physician or nurse practitioner engages the patient and/or substitute decision-maker to go through the website and discuss it with their family members.

To enable this engagement, we have created a prescription pad, a post card and a one-pager (pdf) that can be emailed to patients.

Once the patient has completed the website and discussed it with their family and substitute decision maker, they should be encouraged to come back to see you to get their outstanding questions resolved and you translate their values and preferences into a medical order for the use of life-sustaining treatments.

Click on an image to download the resource

If you do not work in a health care system that has a medical order for the use of life-sustaining treatments (e.g. “Goals of Care Designation Form”, “Medical Order for Life-Sustaining Treatments”, “POLST”, etc.), that is ok. The finalized ‘Dear Doctor’ letter serves as the communication script with future ICU, ER or other doctors making serious illness treatment decisions with your patient or their substitute decision maker. For an example of a health care system that works well with Plan Well Guide’s preferences, click hereThis process is best illustrated in the image below: 

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. Some patients may prefer to work on paper, not online. To accommodate this preference, we have a downloadable paper version of this website where the last 4 pages serve as the equivalent of the ‘Dear Doctor’ letter (see above).

Creating a Culture of Advance Serious Illness Planning in your Practice Setting

It would be ideal for you to create a culture of thinking ahead and planning ahead for future serious illness in your practice setting so patients ‘expect’ that you will discuss it with them and are motivated to prepare in advance for those discussions. But, research has shown that patients expect their doctors to bring up the discussion, but most doctors do not because they feel the patient will not be ready and the conversation will be difficult and take too much time.

This e-platform, Plan Well Guide, addresses this gap. We prepare patients virtually to communicate their values, medical preferences and outstanding questions as it relates to serious illness so they are ‘decisionally ready’ and it will require less of your time and energy.

To help set the expectation that these advance serious planning conversations will happen in your practice setting, we have created the following posters that you can post in your practice setting, in the waiting rooms, hallways, or exam rooms. 

If you have access to a TV/computer screen player in your waiting or exam room where you can control the content of what is broadcast, we recommend you play one of more of the following videos on your screens periodically. If you have questions about accessing the videos for clinic use, please contact us.  

If you are interested in implementing these tools and evaluating the impact of Plan Well Guide in your practice setting, OR  if you are interested in Dr. Heyland giving a presentation or training, please contact him: daren@planwellguide.com

Additional Resources

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.

Downloadable Promotional Materials Kit

In one click, download a zip file containing all of our complimentary promotional materials needed for your practice setting.

Includes: all 6 posters, our informational postcard, and one-pager information sheet

Prescription Pad

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.

Printable Pamphlet (For ordering large quantities from print shop)

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.

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.

How to optimally elicit patients’ values to inform decision-making

Listen to Dr. Heyland explanation of the importance of using constrained values clarification tools, like we use in Plan Well Guide.

How to optimally elicit preferences for life-sustaining treatments

Listen to Dr. Heyland explain concerns about treating patients as ‘informed consumers’ and speak to the need of using decision aids, like Plan Well Guide, before the decision-making encounter

Planning for Serious Illness vs. Planning for Death

Listen to Dr. Heyland explain how planning for serious illness, like COVID-19, is different from planning for your death, like when you have advanced cancer

Advance Instruction Directives: How useful are they?

Listen to Dr. Heyland speak out against the validity and utility of instructional directives and promote the concept of preparing for future shared decision-making, like we do in Plan Well Guide.

Plan Well Guide: Navigating our website

Here’s a quick introduction video to navigating our website. 

If you have comments or feedback regarding this website or suggestions for additional implementation tools, please contact us!