November 2022 Communication Tip

November 2022 Communication Tip

Advance Care Planning (ACP)

This month’s communication tip is about Advance Care Planning (ACP).  According to a key definition from UCSF’s own Rebecca Sudore, MD, “Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. The goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness.”

Increasingly in the HDFCCC, we are making an effort to understand and document (1) patients’ preferences for care in the future if their disease progresses and (2) who might speak for them if they are not able to communicate, in a legal document called an Advance Directive.  The Advance Directive is a document supporting the ACP process.

Here are some basic resources for documenting our ACP discussions with patients, as well as resources to support patients completing an Advance Directive.

  1. All clinicians at UCSF can easily document their ACP discussions using the “.ACP” dot phrase within APEX.    Anywhere in your note, you can type “.ACP” and a brief advance care planning note template (with drop-down menus) will be added to your note.   Within the dot phrase, there are options for free text, a basic discussion template, and one customized for surgeons to use.

The content that you include in your note will also simultaneously appear in the patient’s ACP Navigator for all to have access to.  The ACP Navigator is a part of every UCSF patient’s APEX chart and include scans of Advance Directive and POLST documents, inpatient code status as designated during a prior admission, and all the .ACP notes in APEX for that patient (from you and other providers).

  1. To help patients complete advance directives, UCSF is recommending 2 types of supports. 
    1. The MERI Center for Education in Palliative Care has a monthly, 2-session workshop (currently via zoom) for patients and family to learn about and complete an Advance Directive.  It’s called “What Matters Most.”  Patients can sign up for the workshop here https://meri.ucsf.edu/acp-workshops.  [Patients can find Advance Directive forms and lots of other ACP resources here: https://meri.ucsf.edu/advance-care-planning.]
    2. Prepare for Your Care (Rebecca’s online step-by-step program with video stories) walks patients through completing an Advance Directive, including using an easy-to-read advance directive form.  It’s all available here: https://prepareforyourcare.org/en/brand/ucsf.
  2. Once patients have an Advance Directive complete, to make it legal, it needs to be witnessed by 2 adults (only one can be a family member and neither can be the designated surrogate decision maker or a treating clinician) OR it can be notarized.  I’m excited to announce that FREE advance directive notary services for UCSF patients with cancer will be available starting 11/28/22 (at the end of this month).  The Program Development Manager of the Patient and Family Cancer Support Center (PFCSC) at Mission Bay, Bernardo Diaz has been certified as a notary specifically to serve HDFCCC patients preparing their Advance Directives.

Here are some key points:

·         Patient must be a UCSF patient.

·         Patient must come to the PFCSC suite at UCSF Mission Bay (possible exceptions)

·         Patient must have scheduled appointment prior arriving to the PFCSC

·         Notary Times: Tuesdays, Wednesdays and Fridays (10am-2pm) (possible exceptions)

·         Contact Bernardo Diaz at [email protected] or call (415)-885-3693 for appointments

·         Notary Services will be provided by the Cancer Center at no-cost to patients.

 

  1. Once patients have a legally valid Advance Directive, they can ask clinic front desk staff to upload it to their ACP Navigator in APEX.  And, coming soon, we hope to have a centralized place for HDFCCC patients to send an electronic version (attached to a My Chart message) of their Advance Directive.   For now, clinicians can have patients send it to you and then forward it to your clinic team to upload into the patient’s ACP Navigator.

(BTW, I have a dot phrase you can use that includes these Advance Directive instructions for patients.  You can include in your AVS.  In the SmartPhrase Manager, search “Rabow” and find it as “SMSACPFUINSTRUCTIONS.”)

All My Best,

Mike

PS You can find an archive of my past communication tips on the MERI website: https://meri.ucsf.edu/meri-center-communication-tips.