Advance Care Planning An Introduction
Aims of the session A general introduction to Advance Care Planning. Explore the context in which advance care planning may be appropriate. Discuss how participants could initiate and manage conversations with patients. Signpost participants to further information and support around end of life decisions.
Terminology What does it mean? ADVANCE STATEMENT PREFERED PLACE OF CARE LIVING WILL ADVANCE DECISION TO REFUSE TREATMENT DNAR ADVANCE DIRECTIVE EMERGENCY HEALTHCARE PLANNING
Advance Care Planning (ACP) What is it? Why do we need to do it? Who should do it? When should it be done?
What is ACP? ACP is a Voluntary process of discussion between an individual and their care providers. It is to make clear a person s wishes in anticipation of a deterioration in the individuals condition in the future, with attendant loss of capacity to make decisions and/or ability to communicate wishes to others. National End of Life Care Programme, 2007 5
Why do we need to do it? To identify what patients want To identify what they don t want To enable choices to be shared with key people (family, carers & professionals)
Activity On your post-it notes write down anything about how you would or would not want to be cared for if you were no longer able to tell your carers what you wanted. Only 1 comment per post-it
Who should do it? Me? You? Family? Carers? Healthcare Professionals? Everyone? No one?
Recognising limitations of Competence Complex Legal / Ethical Issues Legal & Medical Consultants ADRTs, Emergency Care Plans and Advance Statements Consultant Clinical Staff & G.P s Facilitate ACP Discussions / Advance Statements Trained Health & Social Care Staff Awareness and understanding of risks and benefits of ACP and the related guidance All involved in direct care 9
Activity In pairs Discuss what you think your role is in initiating a conversation with a patient about the care they want (or do not want) towards the end of their life. Identify barriers to conversation for -you - the patient - family/carers
ACP Principles of Good Practice Review Discuss, review & update at any time, if has capacity Setting Suitable time & place Fully Informed Need to have all the relevant information Assess Capacity Must have capacity at the time the ACP is devised Aware of Limitations Be aware of your limitations and when they are reached Adequate Knowledge Are you the right person to do this?
Cues to start a discussion A patient s request to discuss future care; A new diagnosis of life-limiting or life-threatening illness; A significant change in treatment, eg. complications of dialysis, failure of second-line chemotherapy; Following multiple hospital admissions or crises; A change in care setting, e.g. a move to a nursing home; A deterioration in health.
Initiation of an ACP conversation The conversation should be introduced sensitively The process is voluntary Realistic account of choices should be given Families and carers may be part of the conversation if the patient wishes
Know your limitations! Recognise when to refer the conversation on to an experienced clinician. Know who to refer to locally. Be open with the patient about the need to refer the conversation on. Seek support from local colleagues.
Role play Split into groups of 3 Patient (use notes to guide role play) Professional Observer Swap roles after each scenario, so everyone has the opportunity to take each role.
Feedback What went well? What were the issues? Would you do anything differently?
Local support Local documentation/leaflets What is available? How do you access it? Staff support Who can you go to for help? Patient support What is available?
Deciding Right A north-east initiative for making care decisions in advance All documentation available via NESCN website http://www.nescn.nhs.uk/deciding-right/
Acknowledgements Developed in conjunction with palliative care professionals across the network. Special thanks to palliative care teams across North of Tyne and in South Tyneside NHS Foundation Trust for sharing their work.