Reflecting on the importance of discussing healthcare preferences is always timely. To shed light on this crucial topic, we spoke with Dr. Jesse Delaney, a Palliative Care Specialist and Intensive Care Physician at SHN to better understand what advance care planning truly is – and why it matters for every one of us.
Q: Dr. Delaney, to start off simply—what is advance care planning?
Dr. Delaney: Advance care planning is a process that helps individuals prepare for future healthcare decisions. It’s about more than just medical treatments – it’s about reflecting on and communicating your values, your goals, and how you want to live. These conversations often include your loved ones and your substitute decision-maker – the person who would make healthcare decisions for you if you were unable.
Q: Many people might associate advance care planning with end-of-life care. How are the two connected—or not?
Dr. Delaney: That’s a common misconception. While advance care planning often becomes more relevant as someone’s health declines, it’s not solely about end-of-life care. It’s really about how you want to live, especially if your health changes. Ideally, these conversations happen long before a crisis, not in the middle of one.
Q: Why do you believe these conversations are so important?
Dr. Delaney: These conversations give people a voice in their healthcare – even if they’re no longer able to speak for themselves. They help families feel more confident in making decisions, and they are an important part of the patient-centred care we provide at SHN because they help our care teams align medical treatment with a person’s wishes. It’s empowering.
Q: How do you recommend someone goes about advance care planning?
Dr. Delaney: Everyone should think about what gives your life meaning. What level of independence is important to you? What kinds of activities bring you joy? What would make life worth living – or not – for you? Then, talk about those answers with someone you trust. It can be your spouse, adult child, sibling, primary care provider, or anyone else who would serve as a substitute decision-maker. You don’t have to have all the answers—you just need to start the conversation.
Ultimately, your substitute decision-maker needs to understand your values so they can advocate for care that reflects your wishes, and so that your healthcare team understands you as a person in the broader context of your life so they know what kind of health interventions can help you achieve your goals for care.
Q: Can you provide an example of how SHN promotes advance care planning?
Dr. Delaney: One major initiative is the implementation of the HOMR (Hospitalized One-Year Mortality Risk) in our Epic clinical information system. It’s an application that uses data routinely collected during a patient’s admission to the hospital to automatically help identify whether they are at a higher risk of dying within the year. Among other things, that creates a prompt for us to check in with them about advance care planning because they might benefit from a conversation.
The idea is to have these conversations earlier, while patients are still well enough to fully participate in them. We’re currently piloting this on two medicine units at our General Hospital, with plans to expand across all three hospitals.
Q: How does SHN’s broader community work support advance care planning?
Dr. Delaney: Thanks to a generous gift by donor Bryan Rowntree, SHN established the Bryan & Bette Rowntree Palliative Care Clinical Centre in 2023. This funding allowed us to expand our outpatient palliative care clinics and strengthen our ability to transition patients from hospital to care in the community. That support is helping us reach more people earlier in their illness and in more settings, creating more touchpoints for advance care planning conversations.
Also, through partnerships like the one with Scarborough Palliative Care, we’re creating better continuity of care and sharing information, like advance care plan details. So, even if someone moves between hospital and community settings, we’re all kept on the same page.
Q: Scarborough is one of Canada’s most culturally diverse communities. How do we ensure these conversations are inclusive?
Dr. Delaney: That’s such an important point. Cultural background can deeply influence how someone views health, illness, and end-of-life. We work to provide translated resources—through organizations like Advance Care Planning Ontario, and we’ve translated our screening tools into multiple languages. We’re also looking at how we can use navigators, like our Indigenous Patient Navigator, to support these culturally sensitive conversations.
But we’re also always listening. Part of this work is being open to learning from our community about how they want to be supported.
Q: Final thoughts?
Dr. Delaney: These conversations don’t need to be intimidating. They’re about living well, not just about dying. The more we talk about advance care planning as a natural part of our healthcare journey, the more empowered our patients and families will be to make decisions that reflect their values and goals.
If you are ready to begin your advance care planning journey or want to learn more, visit advancecareplanning.ca/acpday, speak with your physician / care team during your next healthcare visit, or get started now with this tool designed by Advance Care Planning Canada to guide personal thought and conversations with others: