What is Advance Care Planning?

Advance care planning “A process of discussion between an individual and their care providers irrespective of discipline. Family and friends may be included if the individual wishes” if the individual wishes” Discussions should be documented documented regularly reviewed regularly reviewed communicated to key persons in their care communicated to key persons in their care ACP: A Guide for Health and Social Care Staff

Goals of ACP provide clinical care in keeping with patient preferences and values when decision making capacity has been lost provide clinical care in keeping with patient preferences and values when decision making capacity has been lost improve decision making processes improve decision making processes improve patient well being by reducing frequency of under and over treatment improve patient well being by reducing frequency of under and over treatment

What might ACP include? Concerns Concerns Personal goals for care Personal goals for care Important values to the individual Important values to the individual Understanding about illness and prognosis Understanding about illness and prognosis Preferences for types of treatment (health and social) Preferences for types of treatment (health and social) Usually takes place in the context of anticipated deterioration in the future with attendant loss of capacity

Advance care planning Voluntary process Individualised May include advance statements May include ADRT May include preferred place of care Method of recording needs agreement Sharing of information needs agreement Needs capacity Needs education and training Needs more research

Advance Statement (statement of wishes or preferences) A summary of written and oral expressions where people can talk generally about future care, wishes and preferences. Not legally binding. Medical and non-medical matters can be covered.

Advance decision (Advance Directive, Living Will, Advance Refusal of Treatment) Only applies to the refusal of specific treatment Adult over 18 years Made at a time of mental capacity Informed decision, uninfluenced Applies to the situation that later arises at a time when capacity is lost Legally binding Needs continuing discussion and review

Advance decision to refuse treatment (ADRT) Same power as current decisions CHECK - is it valid? Not valid if subsequently created LPA subsequently created LPA treatment is not specified treatment is not specified circumstances specified are not met circumstances specified are not met professional has suspicions….. professional has suspicions…..

Advance decision to refuse treatment Must state that treatment is refused even if life is at risk as a result Must be signed by patient or someone on their behalf and a witness

Assessment of capacity Does the patient understand what the decision is and why they are asked to make it? Does the patient understand what the decision is and why they are asked to make it? Do they understand the consequences of making or not making the decision? Do they understand the consequences of making or not making the decision? Can they retain the information? Can they retain the information? Can they assess it and weigh it up? Can they assess it and weigh it up? Can they communicate their decision? Can they communicate their decision?

ACP is an ongoing and evolving process People change their minds and their plans It is not right for everyone

Might it be different?!?!