Judith BaileyNovember 2014

What is advance care planning?Why consider it- the evidenceWhat about in real life….what are the nuts and bolts?What about here and now?

What is Advance Care Planning

ACP is a process of discussion and shared planning for future health care. It involves patient, whanau and health care professionals.

ACP gives patients the opportunity to develop and express their preferences for end of life care based on:

their personal views and values a better understanding of their current and likely future

health the treatment and care options available.

DNR – evolution process

Why bother?

BMJ 2010

University hospital setting in Australia309 legally competent medical inpatients aged >80 Randomised to receive usual care or usual care plus facilitated advance care planning(ACP) ACP involved:• Assisting people to reflect on goals, values and beliefs• Consider future medical treatment preferences• To appoint a surrogate• To document their wishesCarried out by trained facilitator( nurse or allied health professional)Followed for 6 months or until death

BMJ 2010

Standard plus palliative care:

• Fewer chose aggressive end of life care – (33 vs 54%)

• Higher QoL • Fewer had depression

– (16 vs 38%)

• Median survival longer – (11.6 vs 8.9 months)

• 56 died by six months• end of life wishes more likely to be known and

followed • family members had significantly less

– stress– anxiety– depression

• patient and family satisfaction was higher in the intervention group.

BMJ 2010

What about the nuts and bolts?

Translating what is

important into treatment plans

What is important to patient?

Initiate

Treating doctor needs to be aware

of ACP

Doctor needs to use the plan to inform

treatment/care where appropriate

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Who does advance care planning? Those who want to.• Well people • People with chronic disease • People who are dying

Our job is to offer them the opportunity-it’s all about conversation with people• It’s about giving information they may want• Its about being willing to talk and listen about the hard

and uncertain stuff• It may be about helping document what people want in

ways health professionals will understand

Think about the last person you cared for who has died.What went well? What didn’t go so well?What future planning happen ?Did it impact on how care happened?

Hard conversations-any wisdom to offer?

Consumer information resources:

What happens next? At the least record some notes of these conversations. If using the documents-• Patient held record• Keep a copy • Make sure GP has copy• Update when changes occur or annually• Copy with local hospital• Working with ambulance service

Legal overview

• Sits well with Code of health and disability consumer rights• Advance care planning requires decision-making capacity• Legal place of an advance directive• Absence of capacity (Right 7(4)):

– EPoA (personal welfare)– Clinician makes the decision in the patient’s best

interests:• Ascertain views of patient• Can consider views of other suitable people

What about here and now?

What is available and who are the people involved?TrainingWorking in with the hospitalsAmbulance servicesPublic awareness

Resources

• www.advancecareplanning.co.nz