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
Other Details (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	1246.145.1880
Revision Number	2.0.2
protocol
Valid period start	Valid period start: The date/time that marks the beginning of the valid period of time for this advance care directive.
Valid period end	Valid period end: The date/time that marks the conclusion of the valid period of time for this advance care directive. '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. That may be due to changed personal circumstances/events or local policy.
Review due date	Review due date: The date at which the advance care directive is due to be reviewed. '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. That may be due to changed personal circumstances/events or local policy.
Last updated	Last updated: The date when this advance directive record was last updated. This may not be a formal review but e.g. a typo correction.
Witness	Witness: Personal details of a person who witnesses the completion of the advance care directive. For example, 'John Smith, Lawyer'. Include: openEHR-EHR-CLUSTER.person.v1 and specialisations
Mandate	Mandate: Description of any legislation or other authoritative guidance that apply. For example, 'In England and Wales, advance decisions are covered by the Mental Capacity Act. 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. Mandate: https://en.wikipedia.org/wiki/Jehovah%27s_Witnesses_and_blood_transfusions'. Choice of: Text URI
Digital representation	Digital representation: Digital document, image or video representing the Advance care directive. Include: openEHR-EHR-CLUSTER.media_file.v1 and specialisations
Directive location	Directive location: Information about the physical or digital location of the Advance care directive.
Location	Location: Physical or digital location of the Advance care directive. Choice of: Text URI
Copy holder	Copy holder: Details of a person who has a copy of the Advance care directive. For example, 'John Smith, Lawyer'. Include: openEHR-EHR-CLUSTER.person.v1 and specialisations
Extension	Extension: Additional information required to extend the model with local content or to align with other reference models/formalisms. For example: local information requirements; or additional metadata to align with FHIR. Include: All not explicitly excluded archetypes
data
Type of directive	Type of directive: The type of advance care directive. A short text description of the nature of the advance care directive. 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'. In the UK, advance care directive types include 'Advance Decision', 'Advance Directive' and 'Advance Statement'.
Status	Status: The status of the advance care directive. Coding of the advance care directive status with a terminology is preferred, where possible. Choice of: Coded Text at0044::Present [The individual has an advance care directive.] [SNOMED-CT::410515003 \| Known present] at0045::Absent [The individual does not have an advance care directive.] [SNOMED-CT::410516002 \| Known absent] at0047::Unknown [It is not known whether the individual has an advance care directive.] [SNOMED-CT::261665006 \| Unknown (qualifier value)] Text
Description	Description: Narrative description of the overall advance care directive. May be used to record a narrative overview of the complete advance care directive, which may or may not be supported by structured data. 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.
Condition	Condition: The conditions or situations in which the individual wishes the advance care directive to apply. 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.
Directive detail	Directive detail: Structured details about the advance care directive decisions. This SLOT should also be used to record details for specific conditions or as per national or other local requirements. For example, in the UK, there may be a specific statement about whether to actively prolong life but only during pregnancy. Include: All not explicitly excluded archetypes
Comment	Comment: Additional narrative about the advance care directive not captured in other fields.
Other contributors	Dag Aarhus, Vestre Viken HF, Norway Vebjørn Arntzen, Oslo University Hospital, Norway (openEHR Editor) steve baguley, NDS, United Kingdom Silje Ljosland Bakke, Helse Vest IKT AS, Norway (openEHR Editor) Marcos Barreto, Universidade Federal da Bahia (UFBA), Brazil Ivar Berge, Oslo Universitetssykehus, Norway SB Bhattacharyya, Sudisa Consultancy Services, India Greg Burch, Tiny Medical Apps, United Kingdom Santiago Cammi, Argentina Ady Angelica Castro Acosta, CIBERES-Hospital 12 de Octubre, Spain Kåre Flø, DIPS ASA, Norway Grant Forrest, NHS Scotland, United Kingdom Mikkel Gaup Grønmo, FSE, Helse Nord, Norway (Nasjonal IKT redaktør) Anne Grimstvedt Kvalvik, Haraldsplass Diakonale sykehus, Norway Joost Holslag, Nedap, Netherlands Evelyn Hovenga, EJSH Consulting, Australia Keltie Jamieson, NSHA, Canada Gorazd Kalan, University Medical Centre Ljubljana, Slovenia Lars Morgan Karlsen, DIPS ASA, Norway Heidi Koikkalainen, United Kingdom (openEHR Editor) Tomi Laptoš, Marand, Slovenia Liv Laugen, Oslo University Hospital, Norway, Norway (openEHR Editor) Heather Leslie, Atomica Informatics, Australia (openEHR Editor) Neranga Liyanaarachchi, Ministry of Health, Postgraduate Institute of Medicine, Sri Lanka Manisha Mantri, C-DAC, India Ian McNicoll, freshEHR Clinical Informatics, United Kingdom (openEHR Editor) Paul Miller, SCIMP NHS Scotland, United Kingdom Bjoern Naess, DIPS ASA, Norway Arunakiry Natarajan, management4health, Germany Svenne Naumann, Finnmarkssykehuset, Norway Andrej Orel, Marand d.o.o., Slovenia Jayashree Panickar, Karolinska Institute, Sweden Martin Paulson, Sykehuset i Vestfold, Norway Vanessa Pereira, Better, Portugal SARA PRETE, Abinsula, Italy clovis puttini, Core Consulting, Brazil Gro-Hilde Severinsen, Norwegian center for ehealthresearch, Norway Line Silsand, Universitetssykehuset i Nord-Norge, Norway Laila Storesund, Haraldsplass diakonale sykehus, Norway Norwegian Review Summary, Nasjonal IKT HF, Norway Carita Teien, Retten til en verdig død, Norge Rowan Thomas, St. Vincent's Hospital Melbourne, Australia Katrin Troeltzsch, Nationales Centrum für Tumorerkrankungen (NCT); Universitätsklinikum Heidelberg, Germany John Tore Valand, Helse Bergen, Norway (openEHR Editor) Marit Alice Venheim, Helse Vest IKT, Norway Olav Weyergang-Nielsen, Retten til en verdig død, Norge Wouter Zanen, Eurotranplant, Netherlands Lin Zhang, Taikang Insurance Group, China
Translators	German: Sarah Ballout, MHH-Hannover, ballout.sarah@mh-hannover.de Norwegian Bokmål: Vebjørn Arntzen, Silje Ljosland Bakke, Liv Laugen, Marit Alice Venheim, Oslo University Hospital, Helse Vest IKT AS, Oslo University Hospital, Norway, varntzen@ous-hf.no, silje.ljosland.bakke@helse-vest-ikt.no, liv.laugen@ous-hf.no, marit.alice.venheim@helse-vest-ikt.no Portuguese (Brazil): Vladimir Pizzo, Royal Philips, vrppizzo@gmail.com Dutch: Joost Holslag, Nedap, joost.holslag@nedap.com