Same-day surgery centers need to be part of the conversation about patients’ end-of-life wishes. As surgery centers treat more older patients, this aspect of care is important.
“Healthcare organizations need to be ready to receive, record, and respect people’s end-of-life wishes,” says Kelly McCutcheon Adams, MSW, LICSW, a senior director for the Institute for Healthcare Improvement.
This conversation could begin with asking, “Have you designated a healthcare proxy?” The patient’s answer would be marked in the chart, and there could be a follow-up question along the lines of: “You have designated a healthcare proxy — who is that person?”
Additional questions might include:
- Can we have a copy of the proxy form?
- How do we reach your proxy?
- Does this person know he or she is your proxy?
“One way we talk about the proxy question is we liken it to allergies,” McCutcheon Adams says. “If you open a medical record and a field says, ‘Do you have an allergy,’ and the answer is ‘yes’ — and that was all it said — then all you would know was the person has allergies.” More information is essential, such as what the allergies are.
“We want people to expand their thinking beyond the ‘yes/no’ to ‘Can we have a copy of that, and how do we contact that person?’” she says. “In the same-day surgery setting, this is not the most pressing issue, but it’s important to understand who patients want to speak for them. It might not be the most likely space for this conversation to start, but if all healthcare settings saw that as part of their responsibility, then we would have a much higher level of reliability of these conversations happening.”
Regardless of whether patients have designated a healthcare proxy, this information should be included in patients’ charts. This allows the next healthcare provider to see the answer, that the proxy conversation occurred, and what steps to take next.
Another important part of respecting patients’ end-of-life wishes is to understand what matters most to patients. This goes beyond traditional advance directives. “We really need to have more values-based conversations with patients about what matters to them,” McCutcheon Adams says. “There’s an opportunity [before surgery] to start this conversation and understand why this person is going to the trouble of having this surgery and what they hope it will accomplish for them.”