Advance Care Planning Documents

The focus is to lengthen life using any medical or surgical means. This includes, if needed, resuscitation (CPR) to re-start your heart, intubation (a breathing tube that is attached to a machine that breaths for you) and admission to the intensive care unit. People with a chronic illness tend to do worse than people without a chronic illness if they need this level of care. There are many circumstances where it may not be recommended, but this depends on your level of function and how severe your disease is.

Medical tests and treatments are used to cure or control an illness as much as possible. If your heart stops or you needed a machine to keep you breathing, the practitioners would allow you a comfortable death. This is used when resuscitative and life support measures won’t work or when the person chooses not to have these treatments. If resuscitation were not offered, your practitioners would explain this to you. Medical care can be given in many locations, depending on the person’s wishes, values, and how severe the illnes is. Medical care is very aggressive care, and many illnesses such as heart attacks, infections, bleeding, and clots can be well treated within this designation. Complications from cirrhosis such as fluid in the belly (ascites), confusion (encephalopathy), many types of bleeding, and infections can also be treated under this designation.

The focus of care is to provide comfort to ease a person’s symptoms, without trying to control the underlying illness. Treatments with a main goal of lengthening life are not undertaken. Treatment of conditions that may cause severe symptoms such as infections, mild heart attacks, blood clots, and other, can be considered. These treatments may lengthen life, but the main goal is to provide comfort. There will be a point in everyone’s life, when they no longer want any treatments. Usually when this happens, people are unable to get out of bed, no longer wish to eat, and can tell that their body can no longer tolerate the degree of illness they have. This care can be given in settings such as home, hospital, or hospice, described later in this booklet.

Cirrhosis may affect your body’s ability to recover from illness. Many body functions are controlled through the liver. The degree that your liver is affecting the rest of your body, depends on what complications you have experienced. In addition, it depends on how functional you are in your daily life, for example- if you are up and out of the home all day, if you can care for yourself, or if you are in bed most of the time. All of these things are important to think about when deciding about a Goals of Care designation.

Early in cirrhosis care, these won’t seem like important issues. It is however important to know how the health care system operates in Alberta, as it will help you plan for and understand your future health care options. Having a Goals of Care designation is an important part of this.

A Goals of Care designation (stored in a Green Sleeve) can be documented with any of your practitioners. They should understand your values and your support systems, prior to making these decisions. The decisions may also take some time. Many patients wish to take the information home, and discuss it with their family and other people who support them. The Green Sleeve is available to all practitioners, and you can ask to discuss it at any time.

It is important to understand that GOC designations can be changed at any time. People may wish to reconsider their wishes in many situations, but typically we suggest reviewing the designation in these specific circumstances:

• Any time you need to go to the emergency department or are admitted to the hospital.
• When you experience a new complication of cirrhosis.
• If you are noticing your level of function is getting worse.
• If you experience spiritual, emotional, or social issues that make you reflect on your wishes for your future health.

A Green Sleeve is a plastic pocket that holds your important advance care planning forms.

There are 2 ways to get a Green Sleeve:

• Ask your healthcare provider (such as your family doctor) for a Green Sleeve.
• Order a Green Sleeve online. You can have up to 2 Green Sleeves mailed to your home by following these instructions. It can take 5 to 10 business days for your Green Sleeves to arrive. If you need to order extra Green Sleeves (up to a maximum of 2 per household), or if you have questions about your order, email conversationsmatter@ahs.ca.