What is advance care planning? Advance care planning is the process of planning for future health and personal care whereby a person’s values, beliefs and preferences are made known so they can guide clinical decision making at a future time when that person cannot make or communicate their decisions due to lack of capacity.
Case study: Having the conversation with Linda.
Linda was 64 years old with multiple chronic conditions when she presented at hospital with fever, tiredness and increasing shortness of breath. This left her unable to discuss her care with staff.During a previous admission she’d had a conversation with staff about her wishes for future care and developed an advance care plan. Sue had previously appointed her daughter as her substitute decision maker. She explained that she had enjoyed her independence and was increasingly frustrated about how her illnesses were limiting this.
In particular she had identified that in view of her current health she would not want cardiopulmonary resuscitation, invasive life-prolonging treatments or a transfer to intensive care. She would however accept intravenous antibiotics. This was documented on the health service’s advance care plan form and an alert was placed on her file.
Doctors spoke with family members, particularly her daughter, and they agreed on a course of intravenous antibiotics, but not a bronchoscopy as she had refused such treatment in the past. Her condition deteriorated further. In consultation with the family and in accordance with her advance care plan, the decision was made to provide her with palliative care.
Sue spent her final days with her family, being kept comfortable and free from pain.
Advance care planning can be verbal or written. Ideally, advance care plans are written in order to strengthen their influence on clinical decision making. Both verbal and written advance care plans can result in:
- expression of personal values, preferences for treatment and care
- appointment of a substitute decision maker
Advance care planning is an approach to communication that allows a person to discuss goals, values and choices about their preferred outcomes of care.
Who is advance care planning for?
Advance care planning is relevant to everyone but is particularly important for key groups. This strategy focuses on priority groups of people who would benefit from support to articulate their wishes for future treatment and care. These include:
- aged or older people who are frail
- people of any age with chronic progressive and life-limiting conditions
- people approaching end of life
- people with multiple comorbidities and/or at risk of conditions such as stroke or heart failure
- people with early cognitive impairment.
People undergoing medical or surgical treatment should also have the opportunity to discuss advance care planning. Pharmaceutical interventions and the impact of treatments, both anticipated and unanticipated, may result in transient and temporary loss of capacity.
For further information, please contact Lorne Medical Centre’s Practise Nurse Leanne Jeffrey 52894367.