The Dyadic Approach to Advance Care Planning

Over the last decade, the use of the dyads in healthcare administration has become increasingly commonplace. A dyad is a group of two people; common examples of participants knowing one another include parent and child, teacher and student, spouses, siblings, and friends. In the healthcare setting, the dyad management style teams up a hospital administrator with a physician to run various clinical departments like cardiology, oncology, or emergency services. 

The use of dyads in advance care planning is a communication style in which individuals can discuss and communicate their care preferences for serious illness conditions as a dyad so that there is clarity and understanding of the individual’s choices. The optimal choice of who is present as a dyad would be the anticipated caregiver or trusted medical decision-maker for the individual. 

Over 6 million Americans aged 65 and older are living with Alzheimer's disease, the most common form of dementia. This number is projected to reach nearly 13 million by 2050 due to the aging population. Approximately 500,000 new cases of Alzheimer's disease are diagnosed each year in the U.S. The cost of caring for individuals with Alzheimer's and other dementias is estimated to be $355 billion in 2021, with projections reaching over $1.1 trillion by 2050. 

As the incidence of dementia in the elderly increases, the use of advanced care planning in patients with early-stage dementia is increasingly important to consider early in the course of the disease. 

A study by Yeung studied the feasibility of the dyad approach to ACP in patients with early dementia. Their study found that the dyadic ACP intervention was acceptable to both participants. Using a dyad approach there was increased completion and understanding for individuals’ goals of care as dementia progressed. There were high satisfaction scores achieved for both patients and their caregivers who were involved in the initial ACP dyad method of completion. 

The Thanacare app, used by a wide variety of clinicians, is the ideal tool for the completion of ACPs for individuals in the early stages of dementia. The platform is well suited for the dyad approach to ACP completion by enabling clinicians to easily complete healthcare directives with their clients and trusted medical decision makers in a dyadic format. The platform is easy and accessible for clinicians to use. “Two features are particularly unique to our platform, “Dr. Rick Aizpuru, VP Clinical Solutions for Thanacare recently shared. “Once completed, the clients’ healthcare directives are stored and accessible in the Thanacare registry, and the platform provides for continued client updates through Thanacare’s signature progress notes and video wishes feature.” “The progress note and video feature allow clinicians to nicely document for family members and patients the progression of disease. Unfortunately, as the subtle changes of dementia occur, our Thanacare platform through its progress notes and video feature can help families using video visualize disease progression. The video allows the trusted medical decision maker (power of attorney for healthcare or healthcare surrogate) to honor the patient's choices with increased confidence.” 

Families and caregivers can be reminded by reviewing the progress notes/video clips repeatedly if needed. These videos reinforce the story of decline and provide supportive evidence for the trusted medical decision maker. As they make the appropriate EOL care decisions for their loved one, they are respecting their loved ones wishes. 

The use of dyads early and advanced care plan completion helps to ensure individuals choices are respected, and the addition of the ongoing progress notes and the video component is a unique feature of the Thanacare tool. 

If you are interested in starting a conversation about your advance care plan, and what matters most when it comes to your care wishes, schedule with Thanacare today.