ARCHETYPE Advance care directive (openEHR-EHR-EVALUATION.advance_care_directive.v2)

Name: Advance care directive
License: http://creativecommons.org/licenses/by-sa/4.0/

ARCHETYPE ID	openEHR-EHR-EVALUATION.advance_care_directive.v2
Concept	Advance care directive
Description	A framework to communicate the preferences of an individual for future medical treatment and care.
Use	Use to record the preferences of an individual for future medical treatment and care. Advance care directive may also be known as living will, advance directive, advance decision, advance decision to refuse treatment, personal directive, advance healthcare directive, or medical directive. An advance care directive is commonly used to refuse life-sustaining treatment which may include, but is not limited to: cardiopulmonary resuscitation (CPR); clinically assisted nutrition and hydration; assisted ventilation; and antibiotics for life-threatening infections. It could also include positive preferences and instructions for future health care priorities, living arrangements and personal matters. An individual with capacity may create an advance care directive to record their preferences for medical care and treatment in advance, which is intended to guide decision-making in future situations in which the individual is unable to make or communicate decisions. This archetype has been specifically designed as a framework or structure that can be extended for the complex range of use cases and local requirements by nesting a variety of possible CLUSTER archetypes which will contain specific details as per national or other local requirements. In some countries, an advance care directive is legally persuasive without having an official legal status. In others it is a legally-binding document, and it MUST be ensured that the advance care directive archetype and any nested archetypes adhere to relevant legal requirements.
Misuse	Not to be used to record organ donation preferences. Use a specific archetype for this purpose. Not to be used to record details about a Power of Attorney or other legal representative/proxy. Use a specific archetype for this purpose. Not to be used to record anticipatory decisions about CPR decisions, other possible intervention decisions, and intent of care as asserted by a clinician in a health record. Use the EVALUATION.advance_intervention_decisions archetype for this purpose.
Purpose	To record the preferences of an individual for future medical treatment and care.
References	Advance Care Planning Australia [Internet]. Melbourne: Austin Health; 2018 [cited 2020 Apr 07]. Available from: https://www.advancecareplanning.org.au/. Alberta Health Services [Internet]. Edmonton: Alberta Health Services; 2020. Goals of Care Designation (GCD) Order. 2014 Jan [cited 2020 Feb 17]. Available from: https://www.albertahealthservices.ca/frm-103547.pdf. Compassion in Dying [Internet]. London: Compassion in Dying; 2018. Advance Decision (Living Will) pack; 2018 Jul [cited 2019 Nov 28]. Available from: https://compassionindying.org.uk/library/advance-decision-pack/. Health and Care information models [Internet]. The Hague: NICTIZ; 2019. AdvanceDirective-v3.1(2019EN); 2020 Feb 03 [cited 2020 Feb 17]. Available from: https://zibs.nl/wiki/AdvanceDirective-v3.1(2019EN). health.vic [Internet]. Melbourne: Department of Health & Human Services; 2017-2020. Advance care planning forms [cited 2020 04 07]. Available from: https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/advance-care-planning/acp-forms. LeBlanc TW, Tulsky J. Discussing goals of care [Internet]. Wolters Kluwer; 2018 Oct 29 [cited 2020 Feb 17]. Available from: https://www.uptodate.com/contents/discussing-goals-of-care.
Copyright	© openEHR Foundation
Authors	Author name: Heidi Koikkalainen Organisation: NES Digital Service, Edinburgh Napier University Email: hk.koikkalainen@gmail.com Date originally authored: 2019-10-23
Other Details Language	Author name: Heidi Koikkalainen Organisation: NES Digital Service, Edinburgh Napier University Email: hk.koikkalainen@gmail.com Date originally authored: 2019-10-23
OtherDetails Language Independent	{licence=This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/., custodian_organisation=openEHR Foundation, references=Advance Care Planning Australia [Internet]. Melbourne: Austin Health; 2018 [cited 2020 Apr 07]. Available from: https://www.advancecareplanning.org.au/. Alberta Health Services [Internet]. Edmonton: Alberta Health Services; 2020. Goals of Care Designation (GCD) Order. 2014 Jan [cited 2020 Feb 17]. Available from: https://www.albertahealthservices.ca/frm-103547.pdf. Compassion in Dying [Internet]. London: Compassion in Dying; 2018. Advance Decision (Living Will) pack; 2018 Jul [cited 2019 Nov 28]. Available from: https://compassionindying.org.uk/library/advance-decision-pack/. Health and Care information models [Internet]. The Hague: NICTIZ; 2019. AdvanceDirective-v3.1(2019EN); 2020 Feb 03 [cited 2020 Feb 17]. Available from: https://zibs.nl/wiki/AdvanceDirective-v3.1(2019EN). health.vic [Internet]. Melbourne: Department of Health & Human Services; 2017-2020. Advance care planning forms [cited 2020 04 07]. Available from: https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/advance-care-planning/acp-forms. LeBlanc TW, Tulsky J. Discussing goals of care [Internet]. Wolters Kluwer; 2018 Oct 29 [cited 2020 Feb 17]. Available from: https://www.uptodate.com/contents/discussing-goals-of-care., current_contact=Heidi Koikkalainen, hk.koikkalainen@gmail.com, original_namespace=org.openehr, original_publisher=openEHR Foundation, custodian_namespace=org.openehr, MD5-CAM-1.0.1=EFE9BDEFE0EF572B821B77012E7AF8DD, build_uid=680cdc05-99ef-439f-bc4d-24e6c94a24cc, ip_acknowledgements=This artefact includes content from SNOMED Clinical Terms® (SNOMED CT®) which is copyrighted material of the International Health Terminology Standards Development Organisation (IHTSDO). Where an implementation of this artefact makes use of SNOMED CT content, the implementer must have the appropriate SNOMED CT Affiliate license - for more information contact http://www.snomed.org/snomed-ct/get-snomedct or info@snomed.org., revision=2.0.2}
Keywords	living, will, advance, advanced, directive, decision, legal, preference, EoL, DNR, DNACPR, resuscitation,
Lifecycle	published
UID	5669f1f8-acfb-41f0-a43f-46abc4391f0c
Language used	en
Citeable Identifier	1013.1.6499
Revision Number	2.0.2
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Coding of the type of directive with a terminology is preferred, where possible. It is expected that this is largely localised to reflect local policy and legislation. For example, in the Netherlands, advance care directive types include, but are not limited to, 'Treatment prohibition', 'Treatment prohibition with completion of Completed Life', 'Euthanasia request' and 'Declaration of life'. 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Details of specific structured findings can be included using CLUSTER archetypes in the 'Directive details' slot. This data element may be used to capture legacy data that is not available in a structured format., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0007], code=at0007, itemType=ELEMENT, level=2, text=Condition, description=The conditions or situations in which the individual wishes the advance care directive to apply., comment=For example: dementia, brain injury, diseases of the central nervous system, and terminal illness. Coding with a terminology is preferred, where possible. The advance care directive applies to all specified conditions if the individual can no longer make or communicate decisions about their medical treatment and is unlikely to regain the ability to make such decisions. Details of specific decisions that apply to different conditions or situations can be included using CLUSTER archetypes in the 'Directive details' slot. , uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0052], code=at0052, itemType=SLOT, level=2, text=Directive detail, description=Structured details about the advance care directive decisions., comment=This SLOT should also be used to record details for specific conditions or as per national or other local requirements. 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However, they may need to be recorded separately in circumstances where a document has an extended period of validity but requires an interim review. That may be due to changed personal circumstances/events or local policy., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0010]/items[at0056], code=at0056, itemType=ELEMENT, level=2, text=Review due date, description=The date at which the advance care directive is due to be reviewed., comment='Valid period end' may often overlap with 'Review due date'. However, they may need to be recorded separately in circumstances where a document has an extended period of validity but requires an interim review. 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Mandate: https://www.bma.org.uk/advice/employment/ethics/consent/consent-tool-kit/9-advance-decisions'. Or 'Jehovah's Witnesses believe that the Bible prohibits Christians from accepting blood transfusions. 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