Advance Care Planning (ACP) Georgina Parker Lead Consultant in Palliative Medicine

What is Advance Care Planning?

What is Advance Care Planning?

What is Advance Care Planning? ‘Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. The goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness.’ International  Consensus Definition of Advance Care Planning (Sudore et al 2017) Voluntary process

Outcomes of ACP Statement of wishes and preferences Lasting Power of Attorney Advance Decision to Refuse Treatment Consider preferences and priorities for care, place of care and death, resuscitation Achieve a good death Opening up conversations with family and friends and sharing feelings and concerns

Statement of preferences Can be verbal or written Personal preferences Values and beliefs Treatment preferences Care preferences

Advance Decision to Refuse Treatment Under MCA 2005 Verbal or written (for refusal of life sustaining treatment inc witnessed sig) Refusal of specific treatment in specific circumstances Only comes into effect when lacking capacity Must be valid and applicable

Lasting Power of Attorney for Health and Welfare Under MCA 2005 Health and welfare inc life sustaining treatment (specific instruction) Designated attorney can make all healthcare decisions on behalf of patient Only comes into effect when lacking capacity Specific form and registered with Office of Public Guardian Supersedes ADRT

Relevance of Mental Capacity Capacity needs to be assessed Need to have capacity to write ADRT and appoint LPA ADRT and LPA only come into effect when capacity is lost – legally binding Statement of wishes – no legal status but should be considered when making best interests decisions

Barriers to effective ACP “Fighting talk” Someone else’s responsibility Challenges of sharing data Low awareness and missed opportunities Assumptions about patients’ feelings Concerns about meeting wishes

Having the conversation Any professional can open conversation and LISTEN then handover for further exploration Give “permission” to discuss death and dying Respond to cues Open questions about the future Open directive questions about their preferences for care towards the end of their life Explain potential advantages of ACP Encourage discussion with family

Recording and sharing decisions Share with other health and social care professionals Share with family CPMS

Useful references https://www.macmillan.org.uk/_images/missed-opportunities-end-of-life-advance-care-planning_tcm9-326204.pdf http://www.ncpc.org.uk/sites/default/files/AdvanceCarePlanning.pdf http://www.goldstandardsframework.org.uk/advance-care-planning http://endoflifecareambitions.org.uk/wp-content/uploads/2016/09/Advance-Decisions.pdf https://www.respectprocess.org.uk/