Q: What is healthcare planning?
Healthcare planning is about taking control of your healthcare wishes so your goals, values and preferences are known and can be respected by health providers and those closest to you.
It is one of the most important discussions about your health you can have.
It involves thinking about, discussing, and typically documenting your goals and the types of healthcare you may or may not wish to receive while dealing with serious medical conditions. It also involves designating someone to speak for you if you are unable to speak for yourself.
Q: I feel great! Why should I do this now?
The ideal time to have healthcare planning discussions is when you are feeling well - just like financial planning, which works best when done years in advance of retirement. The earlier you plan, ideally before you reach a health crisis, the more you will benefit.
The American College of Physicians ask that patients undergo healthcare planning (they call it advance care planning) anytime a new chronic condition is diagnosed or there is a significant event or change in your life such as a hospital stay. The American Bar Association recommends reviewing your decisions when any of the following “5 D’s” occurs: Death of a family or friend, Divorce, receive a new Diagnosis, experience a significant Decline in health or reach a new Decade.
Q: Why did we choose the name "Iris"?
Our name reflects the uniqueness and beauty of each individual. The “eyes are the windows of the soul”, and each person's iris is unique to them. Your health care should be the same - unique to you and a reflection of who you are. Our first commitment is to ensure our service is deeply personalized, empowering you to receive healthcare that is like your iris, completely unique to you.
Questions about the benefits of ACP:
Q: I already have a living will, DNR or other documents, why do I need this service?
Creating these documents without the support of a trained facilitator can be like baking a cake without a recipe. The value of the plans is only as high as the quality of the thought and discussion that went into creating it. Healthcare planning is all about having high quality discussions with trained facilitators, leading to high quality decisions and documented plans.
Many of our customers that already have some of these documents decide to make changes or significant additions to them after speaking with our trained facilitators, personalizing them to incorporate their own goals and preferences. We regularly find that people living with serious medical conditions don’t know what they don’t know. Our facilitators and online tools provide many insights along the way that can have profound impacts on your goals and preferences. Once your forms are complete and fully personalized, we also handle the critical final step that many completely ignore: distributing these important documents (at your direction) to your family, friends, doctors, hospital and statewide advanced directive registry if available. You talk about several proven benefits -- what is the evidence that ACP:
...Improves my quality of care?
There is strong evidence that this kind of planning improves the experience of care for both the patient and their caregivers / family. One study published in the Journal of the American Geriatrics Society was conducted to determine whether advance care planning affected quality of care for 4,000+ people. Patients had higher satisfaction with their care, especially the communication and decision making aspects. Healthcare planning was shown to reduce hospitalization time and increased participation in hospice. Finally, it was shown to relieve stress for the patient, their caregivers and their family.
...Allows me to get the care I want?
Studies demonstrate healthcare planning helps patients get the care they want. A study of 3,500+ patients published in the New England Journal of Medicine concluded that performing this type of planning and having advance directives on file at the doctor’s office and/or hospital was strongly associated with patients receiving the care they wanted. The study also concluded that more than one quarter of elderly patients need a surrogate decision maker during advanced illness.
...Reduces stress on my caregivers, family or loved ones?
Studies have demonstrated healthcare planning reduces stress on caregivers, including family or other loved ones. One of these studies published by the Annals of the American Thoracic Society found caregivers who had engaged in healthcare planning conversations were significantly more likely to know the patient’s treatment goals resulting in lower levels of conflict compared to those who had not. It also helps loved ones and caregivers avoid feeling depressed, nervous, and other physical ailments.
...Assists me in living longer?
Studies have demonstrated healthcare planning or helps patients live longer. One study published in the New England Journal of Medicine of patients diagnosed with lung cancer demonstrated early palliative care (of which healthcare planning is the main component) was associated with 25% longer patient survival times.
Think about it like this. At some point in the journey through medical care the treatments can become more burdensome, more toxic, or more difficult. Those negative effects begin to outweigh the benefits. A good example of this is some of the opioid pain medications for back pain. They often do not improve quality of life by improving the ability to walk or work yet the negative side effects of the medication persists like drowsiness, nausea and constipation persist. When patients are empowered with information they tend to avoid treatments that are not benefitting them. This gives them the energy to be more engaged, productive, and feeling better.
Questions about my appointment:
Q: How does the video conference work?
You and any other participants you choose will receive a link to a confidential Iris Plans video conferencing session via email. At the time of the call, you click on this link to join the video conference. Our video conference service runs well on computers, tablets or smartphones. We typically call your phone at the beginning of the session to help address any issues you have joining the video conference.
Q: What if I get sick the day of my appointment?
We understand - just let us know as soon as possible. You or your family should call Iris Plans right away to reschedule as needed.
Questions about advance directive forms:
Q: What is the difference between medical power of attorney and durable power of attorney?
A durable power of attorney addresses your wishes related to who you would like to make decisions for your personal property if you are unable. A medical power of attorney addresses your wishes related who can speak on your behalf for medical decisions if you are unable. Both are important.
A medical power of attorney only goes into effect if you are unable to speak for yourself. A medical power of attorney’s role is to relay your wishes to healthcare providers, not their wishes for your care.
Q: What is the difference between a medical power of attorney and a living will?
A medical power of attorney allows you to name someone you trust to make medical decisions on your behalf if you are unable to speak for yourself. A living will (also known as a directive to physicians), can include a medical power of attorney, but goes into detail about your specific wishes about aggressive treatment in the event of serious illness. Both of these forms are specific to your state of residence.
Q: What if I change my mind or my situation changes? Can I update these forms? I feel like I won't know what I think until I'm in that situation.
Absolutely! You remain in the "driver’s seat." You can make changes to these as often as you like. Your plan of care remains flexible and your wishes should be communicated to healthcare providers every time you are admitted to and at any point during an admission to a healthcare facility and at least annually with your primary care provider.
Q: Can I schedule more time with an Iris Plans facilitator?
You can schedule additional sessions with an Iris Plans facilitator any time. Everyone is different and we will take the time you need to get this done right. Depending on the plan you have purchased, this may require upgrading your plan.
Questions related to my healthcare team:
Q: Shouldn't my primary care provider be participating in these sessions?
Your doctor is always welcome to participate in your Iris Plans sessions. We know they are busy, so even if they are not present for the conversations, Iris Plans will deliver your documents to their office for review. You and your doctor can choose to continue the conversation after your Iris Plans session to make sure they have all of the information about your goals and preferences.
Q: Will healthcare providers/doctors, hospitals and nursing homes respect my choices, once I complete these documents?
Healthcare providers have a duty to respect your wishes when providing your care, and there is good evidence that communication of your thoughts to family and healthcare providers is essential to ensuring your care is carried out based on your wishes. Without this personal information, decisions can easily result in providers focusing on standardized medical protocols instead of your particular needs.
Q: I have a lot of health problems and symptoms like pain and nausea. Do Iris Plans facilitators help treat these problems?
Iris Plans facilitators participate in the healthcare planning portion of your care only and do not provide medical diagnosis or symptom treatment recommendations. Symptom management is the responsibility of your medical team(s).
Questions related to my family:
Q: My family is already too tired from taking care of me to know. I don't want to add one more thing to their "to do" list.
Healthcare planning significantly reduces decision making burden on family members and in doing so supports their emotional health.
Q: Can I still participate even if my family doesn't want to?
Absolutely! Iris Plans facilitators are happy to work with you one on one to develop your personalized plan.
Q: What if another family member needs to do this too? Can we do them together?
Families can book back-to-back appointments for convenience to allow us to focus on one individual at a time.
Q: My children don't agree with my decisions. What if they try to stop my plan when I can't speak for myself?
Healthcare providers have a legal and ethical duty to respect your wishes when documentation of your wishes is present. Having this documentation available when you receive care reduces conflict between family and providers and helps to ensure your wishes are respected.I’m worried about doing this because my family has discussed this before and we don’t agree. It is extremely important to have these sessions particularly if you know you already have disagreement between family members. Iris plans service facilitators are skilled in helping families problem solve through differences in opinion about care choices.
Q:I’m worried about doing this because my family has discussed this before and we don’t agree. What should I do?
It is extremely important to have ACP sessions particularly if you know you already have disagreement between family members. Iris plans service facilitators are skilled in helping family’s problem solve through differences in opinion about care choices.