Scenario 1: A 52 y.o. patient with history of COPD and muscular dystrophy, admitted for nocturnal BiPAP implementation. This video shows patient-doctor discussions about treatment and care management options, identifying and updating previously recorded information on nominated next of kin according to patient's wish.
Scenario 2: A 56 y.o. male patient with chronic renal failure, undergoing dialysis treatment. The patient is well enough to make informed consent about his treatment plan and communicates this with his nurse.
Scenario 3: A 35 y.o. patient transferred to the ward following presentation at ED due to acute respiratory failure. The video shows communication between patient and physician, clarifying and updating of medical record to reflect patient's wishes and nominated person to act on his behalf.
Scenario 4: A 67 y.o. woman admitted to hospital following sepsis on the background of GuillainBarr syndrome. The video shows the importance of identifying a nominated representative or spokesperson for a patient while cognitively capable in the event that communication becomes a problem for medical treatment. Communication about the medical treatment delivered in a manner that is clearly understood by patient.
Patient 1 – Ron, 52 year old man
Narrative: When a patient’s condition changes, this can be a good opportunity to bring up a discussion about future treatments and to clarify previously recorded documentation relating to their decisions.
Doctor: It’s unfortunate that you had to come back to the ward again. I think it’s probably about time that we had a bit of a discussion about how you are going with your breathing problems and what we do with your treatment from now on. It says here that your son is listed as your next of kin. Is he the person you would like us to be speaking to?
Patient: I would like you to speak to my brother.
Doctor: Oh yeah. What’s his name?
Doctor: Les. It might be good if we could get him in so we could have a bit of a chat. Would it be alright with you if I gave him a call so that we could all get together and have that talk? Would that be alright with you?
Patient: Yeah. Yeah.
Doctor: Do you an idea yourself about what you’d like?
Patient: Yes I do.
Patient 2 – Andrew, 56 year old man
Narrative: Discussions should be brought up when having consultations with patients’ about their current treatments, and should be done when patients are clearly well enough to make decisions.
(no voice only machine sound in background from time 1:34 to 1:39)
Doctor: Alright. That’s great Andrew. Thank you for all that information. There’s just one last thing I would like to check and that is, if something was to happen while you are in here having dialysis, is there someone that you would like us to call that would be able to make your medical decisions for you if you were unable to at the moment?
Patient: Yeah. I’ve got my wife and I’ve also got my, my oldest child. Although all my children are, are aware of this situation, but my wife and my oldest child are the contact points.
Doctor: Have we got her details in our system?
Patient: You have, yes.
Doctor: Oh great.
Patient: and mobiles.
Doctor: Excellent, and have you had discussions with them about what medical treatments you would or wouldn’t want under certain situations?
Patient: Yes I have.
Doctor: ahh great. I will add them to our contact details and I will have a discussion about that with the rest of the team so that we know in future we’ve got their numbers here and ready to go at the front of your history.
Patient 3 – Wayne, 35 year old man
Narrator: The information stored in patients’ records should be checked, clarified and possibly altered depending on the patient’s wishes. This ensures that patients’ decisions are understood and accurately reflected.
Doctor: So, I have just about come the conclusion of my admission. Ahh…there is only one more thing I want to clarify. On your contact details it says it has your mother as your next point of contact and that would be the person that we would contact should you become more unwell. Is, is that correct?
Patient: (patient shakes head) No it isn’t.
Doctor: No, and who would be the best person that we contact?
Patient: That would be my partner.
Doctor: Your partner. Okay. The reason why I ask is that you have obviously come into hospital unwell and we are doing the admission as we speak but with most hospital admissions there, we do expect you to get better but in the unforeseen event that you do get worse, and you are unable to make any medical decisions by yourself, this person would be the best person that we contact that has your best interests at hand. So is your partner, would your partner be an appropriate person to list as your next of kin to be able to make those decisions on your behalf?
Patient: She would be the most appropriate.
Doctor: Okay. No worries. I’ll put, I will change the number. Okay. I think we’re done.
Patient: Thank you.
Patient 4 – Maureen, 67 year old woman
Narrator: in the instance that a patient is unable to communicate verbally, but is still cognitively capable, appropriate steps must be taken to ensure their wishes are known and recorded.
(no voice, doctor walking to bedside 4:38 to 4:40)
Doctor: Hi Maureen. I’ve just come to have a chat to you about your consent for your PEG insertion, so, that’s the feeding tube which is going to be put into your stomach. But, before we talk about that I thought it a good opportunity to discuss if in the event that something were to not to go as planned if you’ve thought about what things, that what your decisions would be about certain interventions, and you know if you have thought about it if you have discussed it with anyone.
Patient: (nods, I have)
Doctor: You have. Okay…….so I’m sorry, and you are?
Jenny: I’m Jenny, Maureen’s friend. We’ve talked about this before.
Doctor: Okay. Terrific.
Jenny: We’re very close.
Doctor: and she’s elected you if I understand to be her spokesperson in the event that you (Maureen) are unable to. So whilst we can communicate that’s fine. But just if you weren’t able to, I understand Jenny will be your representative?
Patient: (nods, yes)
Doctor: okay. Good. Terrific. Thank you for that. That helps us.
(end time: 5:35)
Once these discussions have been initiated doctors can comfortably formalise patients’ wishes by
- (introducing the topic) of advance care planning.
- (explore concepts) relating to medical intervention and choices surrounding these.
- (introduce solutions) for these so patients through completing the documents and recording their wishes. And finally to
(summarise) these discussions, ensuring patients have full comprehension, clarity and consent over the information recorded.