Honoring Your Health Care Choices

Too often, we don’t receive the health care we wish for near the end of life or in medical emergencies. We don’t because we haven’t clarified what our wishes are. But starting a conversation about such situations can be difficult, whether with doctors, family members, religious and community leaders, or health care providers. It is, however, necessary that these conversations happen. And once they occur, it is equally critical that people’s choices are known and honored by those who care for them.

Honoring Choices Wisconsin (HCW) is an initiative of the Wisconsin Medical Society to make the system work better for everyone by creating systematic change, by advocating for patients, and by offering helpful education around advance care planning. Through HCW, the Wisconsin Medical Society is serving as convener, coordinator, and catalyst to make advance care planning a routine and standard part of care across Wisconsin.

Making your health-care wishes known

It doesn’t matter whether you’re 18 or 80. It’s important to think about what kind of health-care treatment you want if you become ill and cannot make decisions for yourself.

Advance directives allow you to put your wishes in writing before a crisis. Without these documents, you risk having the state or court make decisions for you. Common types of advance directives include:

• Advance Directive for Health Care — allows you to stipulate what type of life-prolonging care you want if you cannot make decisions for yourself. It’s also known as a living will.
• Durable Power of Attorney for Health Care — allows you to name someone to make health-care decisions for you when you cannot make them for yourself. The designated person is required by law to follow the wishes stated in your directives.

 Clinical Training and Guidance

HCW trains participating health care organizations to build strong advance care planning systems (Southwest Health has been an active participating member of HCW since 2016). More than just training facilitators, HCW assists organizations to ensure that conversations are offered routinely, scheduled, conducted, documented and entered consistently in patients’ medical records. Participating health care organizations begin with a small scale, six-month trial implementation, and use what they learn to create changes organization wide. The concepts, methodologies, training systems and materials are those of the Respecting Choices First Steps model. Respecting Choices is a pioneering program in advance care planning based in LaCrosse, Wisconsin. Honoring Choices Wisconsin faculty, certified through Respecting Choices, provide training and consultation from the first days of implementation to create working, sustainable programs.

Collaboration in the Health Care System

By agreeing to collaborate and not compete around this model, clinical sites and communities enjoy greater benefits and avoid duplicating work to improve advance care planning. As convener, the Society provides a platform for teams and stakeholders to share lessons and information, address challenges, and share successes. The Society disseminates program materials, templates for action, and shared knowledge in person, through regular conference calls, and an annual conference.

Physician Engagement

Physicians are essential to effective advance care planning. Their encouragement helps these difficult conversations go smoothly for their patients, and their leadership helps create successful change in the health care setting. As the voice of medicine in Wisconsin, the Society works closely with physicians and provides them with tools, along with continuing medical education, to successfully engage their patients in advance care planning.

Common Language, Documentation, and Patient Materials

The language around advance care planning is often confusing and unclear. HCW’s Glossary is contributing to the standardization of the vocabulary across Wisconsin. HCW participants use a common tools and materials, and that provides consistency of communication on advance care planning.

Measuring Success

HCW routinely collects data on the number of conversations offered, scheduled, and conducted by its participants. We also measure patient and agent satisfaction with conversations and facilitator competence and confidence. In the long term, the program will make significant changes in the number of Wisconsinites with advance care plans and documents while helping health care organizations achieve greater successful in meeting patient wishes during medical crises and at the end of life. And it’s anticipated that will mean patients and their families will get more of the care they truly wish for as they navigate these difficult situations.

The people of southwest Wisconsin can rest assured Southwest Health is part of this state wide program. The information and education provided are a great benefit to both our care givers and the people we serve.

Make sure your family and physician are aware of your advance directives. If you are interested in advance care planning and completing an advance directive, free forms as well as help and advice are all available at Southwest Health. Contact Jessica Worek, Social Worker, at 608-342-4758.