A Structured Clinical Intervention Framework to Better Anticipate Medical Decisions in Case of Serious Illness or End-of-Life

In North America, without clear indications in their medical records, individuals are likely to receive all necessary life-prolonging treatments, including cardiopulmonary resuscitation and mechanical ventilation—interventions that can extend life but do not necessarily enhance its quality.

An article published this week in Cahiers francophones de soins palliatifs proposes a structured clinical intervention framework based on six patient profiles. This model helps tailor advance care planning interventions according to an individual’s evolving health status.

The first profile includes healthy individuals who should be given opportunities to increase their death literacy through public health initiatives. The second profile involves healthy individuals suddenly facing a severe illness or major surgery, requiring rapid decision-making. This innovative model promotes an evolving, interdisciplinary approach, emphasizing the role of social workers and fostering an ongoing, open dialogue about care preferences.

This framework can also guide the implementation of an integrated palliative care approach. Unlike traditional palliative care, which is often limited to the final weeks of life, integrated palliative care is combined alongside curative treatments in a long-term, quality-of-life-focused approach. From the moment a serious or chronic illness is diagnosed, the goal is to support well-being, relieve suffering, and facilitate conversations about personal values and care preferences.

Improving Death Literacy for Greater Autonomy

Death literacy refers to an individual’s ability to understand and anticipate end-of-life issues. Today, the lack of open conversations about medical decisions in serious illness and end-of-life scenarios often leads to choices made in crisis situations—decisions that may not align with the person's values or wishes.

Enhancing death literacy requires several key actions:

✅ Informing and educating the public about life-sustaining interventions and various end-of-life care options.

✅ Encouraging family and community discussions about values and preferences regarding serious illness and end-of-life care.

✅ Integrating advance care planning into healthcare pathways from the moment a chronic or life-threatening diagnosis is made.

✅ Training healthcare professionals and those working in the not-for-profit sector to facilitate these conversations with empathy and proactivity.

A Necessary Transformation in End-of-Life Care

The adaptation and integration of this clinical framework could represent a major advancement in humanizing end-of-life care. By anticipating medical decisions and strengthening death literacy, we can build a society where dying is not synonymous with uncertainty or decisions being made by uninformed family members or overwhelmed medical staff.

📖 Reference: Cahiers francophones de soins palliatifs