Today (April 16) is National Advance Care Planning Day, an annual event to raise awareness about detailing what kind of care you wish at the end of life and to confirm a future substitute decision-maker who can communicate your wishes and beliefs about future health care, and make decisions when you are no longer mentally capable of doing so. In this conversation, Lee Fairclough, VP for Quality Improvement at Health Quality Ontario, and Kathy Kastner, a long-standing advocate and coach for appropriate end-of-life care and planning, discuss this issue.
Lee Fairclough: In the last few years, we have seen many campaigns in Ontario and across Canada raising awareness about advance care planning. These campaigns are having an impact. Findings from the 2017 Commonwealth Fund International Health Planning Survey of Older Adults showed more senior Ontarians have had discussions relating to issues of advance care planning and substitute decision making than almost any other country or jurisdiction in Canada. That study found that:
• 70% of older Ontarians report having a discussion with family, a close friend or a health care professional about what health care treatment they would want or not want if they became very ill or injured and could not make decisions for themselves
• 47% of older Ontarians report having a written plan or document describing the health care treatment they would want or not want at the end of their life
• 70% of older Ontarians report having a written document that names someone to make treatment decisions for them if they cannot make decisions for themselves
As a society, we are thinking more about dying and end-of-life care as well as earlier and more effective palliative care.
Informing and connecting: If social media is supporting the development of quality care in Ontario and elsewhere, it is through effectively performing these two key tasks.
While social media may still only be used by a portion of health care providers, policy-makers and patients in the province, the platforms we have come to associate with social media – Twitter, Facebook, LinkedIn etc. – can be influential in supporting quality care initiatives.
In developing a system that we wish to be patient-centred, social media has emerged as an important platform for allowing patients and members of the public to engage with health care providers and policy-makers to make their views clear. The degree of interaction between those with lived experience with a disease or illness with those providing their care is unprecedented thanks to online communities and social media like Twitter.
The Twitter hashtag #metoomedicine, galvanized women physicians and their supporters through Twitter to demand more equity and gender equality within the medical profession and has helped bring a much higher profile to this issue. It is an example of how social media has emerged as a powerful tool for helping health care providers share their experiences and insights. It can also help providers deal with their challenges to support the fourth pillar of the Quadruple Aim in quality care – that of enhancing provider wellbeing (although to be fair, social media can also impede this by adding more time pressures to already stressed providers or exposing practitioners to frankly hostile or upsetting views or individuals).
Robotic nurses are caring for the elderly and assisting with surgery - computers are helping to diagnose cancer and plan personalized treatment plans. This is not the future, this is happening now.
Welcome to the era of robotics, artificial intelligence (AI) and big data. Technically nimble and visually adept robots combined with deep learning machines with access to large (and rapidly increasing) amounts of cloud-based data are poised to make unprecedented in-roads into the current technical and cognitive roles of different health care professionals.
“The only constant is change”, a quote attributed to the Greek philosopher Heraclitus, feels particularly true in healthcare.
Healthcare systems around the world seem to be in an almost constant state of change.
Relationships are the bedrock upon which our health care system is built.
Nowhere was this described with more eloquence than at the recent Health Quality Transformation (HQT) conference in Toronto, where keynote speakers Dr. Don Berwick and Kim Katrin Milan both addressed this issue from very different perspectives.