Advanced Care Planning Dr Jacky Payne Balmore Park Surgery

The Times 8/3/17 80% people say they never discuss their own death 50% couples say they do not know their partner’s end of life wishes >66% adults haven’t written a will 25% GPs admit to avoiding talking about death with their patients National Council for Palliative Care and the Dying Matters Campaign

Advanced Care Planning A process to help patients make decisions about future care. Usually used in context of progressive illness and expected deterioration Voluntary Changeable Particularly important in event of loss of capacity

ACP Discussions are centered on the beliefs, goals and values of individuals rather than on specific outcomes or interventions

Benefits To Patients Less aggressive medical care and better quality of life near death Decreased rates of hospital admission, especially from care homes Increased rate of hospice admissions Decreased total number of days in hospital in last year of life

Benefits to Family Helps resolve conflict Wishes of patients are more commonly followed (Australian study showed 86% if ACP vs 30% without) Family members showed lower level of psychological illness following death of relative with ACP

End of life discussions should not take place at the end of life Advanced Care Planning is about the ‘what ifs’ that may occur across an entire lifespan End of life discussions should not take place at the end of life I have an Advanced Care Plan not because I have a serious illness but because I have a family It always seems too early until it’s too late It’s difficult to have an end of life talk through an ET tube

ACP 1. What do you want? 2. What do you not want? 3. Who do you want to speak for you?

What do you want? Advanced statement of wishes and preferences (AS) -Place of care -Acceptable treatment -Place of death -Care after death -Funeral arrangements

What do you not want? ADRT-Advanced Decision to Refuse treatment -Hospital admission -Investigations -Ventilation/Life Support -IV antibiotics -Surgery DNACPR-Do Not Attempt Cardiopulmonary Resuscitation

Who will speak for you? LPA-Lasting Power of Attorney