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

2. What is Advance Care Planning?

3. What is Advance Care Planning?

4. 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

5. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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

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

15. Useful references