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As a hospitalist at Michael ¾ÅÓÎÌåÓý (MGH), Dr. Nadia Incardona witnesses first-hand how Substitute Decision Makers (SDMs) struggle to make complex decisions when their loved ones are admitted with a serious illness.

She sees children faced with making decisions for a parent and families who can’t agree about what decision to make.

“The challenge of making a decision on behalf of another person is hard at the best of times. It can be even more challenging when you have to do this in a stressful and sometimes frightening context of an acute illness,� says Dr. Incardona.

Dr. Incardona sees a real need to help patients and SDMs prepare for these situations.

This is where Advance Care Planning (ACP) can help � and National ACP Day on April 16 is a great time to start.

“If you haven’t had a conversation with your SDM, maybe now’s the time, says Dr. Incardona. “If you’re a health care provider and you want to make this part of your practice, maybe this is the year.�

It was through Dr. Incardona’s experiences as a hospitalist and now as an emergency physician that motivated her to go back to the University of Toronto to obtain a Masters in Health Sciences (Bioethics) and get more involved with Advance Care Planning.

In her role as a Clinical Advisor to Hospice Palliative Care Ontario (HPCO) Advance Care Planning and Health Care Consent group, Dr. Incardona continues to work towards educating health care providers and the public to become more comfortable with having these important conversations � and make them a routine part of patient care.

Dr. Incardona offers five pieces of advice to guide your conversations:  

1. Know who your SDM is:  In Ontario, everyone automatically has an SDM. Make sure you know who yours is. Is this the person you would want to make health care decisions on your behalf if you’re not capable? If not, consider appointing an Attorney for Personal Care.  At patient registration, MGH now asks and records a patient’s SDM rather than an Emergency contact.
2. Learn about any illnesses you have:  Get an idea about the way things may progress over time. Ask health care providers about anything you don’t understand. Share this with your SDM so they learn about your illness too.
3. Reflect on your values, beliefs and what is important to you:  Consider how these very personal factors influence the type of health care choices you make. Help your SDM understand what is most important to you.
4. Focus on quality of life rather than treatment options in your conversations:  Help your SDM understand what conditions would be both acceptable and unacceptable to you. This may help them make decisions on your behalf in a variety of situations.
5. It’s about conversations, not filling out forms:  Although some people choose to write things down, it’s most important that your SDM knows your wishes and what’s important to you. If you are no longer capable of making decisions, health care providers must get consent from your SDM, not through what’s written on a piece of paper.

Related Information

• Join Dr. Incardona for “What You Need to Know to Start and Continue the Conversationâ€�, Thursday, April 25, 12:30-1:30 p.m. at Michael ¾ÅÓÎÌåÓý, G2 Conference Room
• Learn more about Advanced Care Planning