POV: ACP Tale of Two Brothers

APCs are not only helpful in planning for end-of-life care, but also ease emergent healthcare decisions. Quicker decision making will improve patient outcomes in the long term. Here is a story about two brothers who had strokes, and how having an ACP made a difference in one brother's outcome.

Brother #1

Brother #1 had a wakeup stroke. In his ACP, he had stated that he wanted as few deficits as possible. Since the doctors knew his wishes, they were able to make decisions that were in line with his goals more efficiently. He went on to make a meaningful recovery. He had one month of inpatient therapy and then discharged with outpatient physical therapy and occupational therapy. He had no falls or readmissions and resumed his normal life independently.

Brother #2

Brother #2 also had a stroke but did not have an ACP in place. The doctors did not know his wishes, so they had to make decisions based on what they thought was best for him. This resulted in two months of TCU care and therapy. After being discharged with physical therapy in home visits, he ended up falling twice. This resulted in broken ribs, a broken wrist, two ED visits. After a third ED visit from a recurrent stroke, he broke his ankle and was admitted to the ER for a fourth time. Brother #2 was discharged to a nursing home permanently on account of his incidents.

The story of these two brothers illustrates the importance of ACP. Knowing a person’s healthcare goals aids in quick decision making which leads to a better outcome as shown for brother number one. The same cannot be said for brother number two. Providing the right care at the right time to the right patient makes everyone more successful. People need access to care that helps them and aligns with their goals. The first step is knowing what the patient’s goals are and sharing them with their families. For brother one, he wanted as few deficits as possible, to live as independently as possible, and be able to interact with his family in a meaningful way. He was given an aggressive treatment option knowing that it could help to recover his left side, speech, and swallowing function or it could give him a bleed by his brainstem which could have led to death. Making the decision to proceed with the aggressive treatment option became the clear choice for this individual. Life and healthcare decisions can be difficult. Sometimes decisions need to be made knowing that things may never be the way they once were. Helping patients prepare for a life changing event will better prepare them to navigate the kind of care they need. Knowing what kind of care patients hope to access in the future means you can be prepared by bringing in the right kind of specialists in the correct quantity. Helping patients and their families prepare for life changing and life ending events will better prepare them for discussions about care and treatment plans. When ACPs can be uniformly accessed by the care providers, they will save time by being able to offer care and treatment plans that align with the patient’s goals and wishes. This can help patients, their families, healthcare providers, and healthcare organizations better prepare for the future.

‍

‍