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Review

Just ask: discussing goals of care with patients in hospital with serious illness

John J. You, Robert A. Fowler and Daren K. Heyland
CMAJ April 01, 2014 186 (6) 425-432; DOI: https://doi.org/10.1503/cmaj.121274
John J. You
Department of Medicine and Department of Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Department of Medicine (Fowler), University of Toronto, Toronto, Ont.; Department of Medicine (Heyland), Queen’s University, Kingston, Ont.
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  • For correspondence: jyou@mcmaster.ca
Robert A. Fowler
Department of Medicine and Department of Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Department of Medicine (Fowler), University of Toronto, Toronto, Ont.; Department of Medicine (Heyland), Queen’s University, Kingston, Ont.
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Daren K. Heyland
Department of Medicine and Department of Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Department of Medicine (Fowler), University of Toronto, Toronto, Ont.; Department of Medicine (Heyland), Queen’s University, Kingston, Ont.
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  • Everyone admitted to hospital has an advance care plan
    Stephen R Workman
    Posted on: 04 April 2014
  • Posted on: (4 April 2014)
    Page navigation anchor for Everyone admitted to hospital has an advance care plan
    Everyone admitted to hospital has an advance care plan
    • Stephen R Workman, physician

    Heyland and his coauthors describe the problem of patients who do not wish to establish advance care plans. They observe that "It is important to be sensitive to this [preference] and to recognize that such conversations are a process rather than a single event. If one senses a lack of readiness on the part of the patient, it may be useful to address barriers..."

    As well as addressing barriers, physicians carin...

    Show More

    Heyland and his coauthors describe the problem of patients who do not wish to establish advance care plans. They observe that "It is important to be sensitive to this [preference] and to recognize that such conversations are a process rather than a single event. If one senses a lack of readiness on the part of the patient, it may be useful to address barriers..."

    As well as addressing barriers, physicians caring for patients at risk of dying have a strong ethical obligation to tell patients and their families about hospital policy, usually full code by default, even in the face of patient preferences not to engage in advance care planning.

    'Of course you do not have to decide what you want at this time, but in the absence of your decision, hospital policy, including CPR and admission to an ICU would be undertaken if you were to become seriously ill or die suddenly. Do you know if you would or would not want these kinds of treatments?'

    The absence of advance care planning does not result in the absence of advance care plans.

    Conflict of Interest:

    None declared

    Show Less
    Competing Interests: None declared.
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Canadian Medical Association Journal: 186 (6)
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Vol. 186, Issue 6
1 Apr 2014
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Just ask: discussing goals of care with patients in hospital with serious illness
John J. You, Robert A. Fowler, Daren K. Heyland
CMAJ Apr 2014, 186 (6) 425-432; DOI: 10.1503/cmaj.121274

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Just ask: discussing goals of care with patients in hospital with serious illness
John J. You, Robert A. Fowler, Daren K. Heyland
CMAJ Apr 2014, 186 (6) 425-432; DOI: 10.1503/cmaj.121274
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