Advance Care Planning for Practice Nurses Have a box of the A4 tool as well the introductory leaflet to give out as handouts.

What does this term mean to you? Advance Care Planning What does this term mean to you? Call out Optional: Capture onto flipchart & briefly discuss any words, phrases, delegates associate with this term– acknowledge that they are likely to have diverse ideas, experiences and opinions and that this is fine. Lets now see what national guidance we have around this subject…

Advance Care Planning ‘ACP is a voluntary process of discussion about future care between an individual and their care providers, irrespective of discipline’. End of Life Care Programme(2008) Some definitions..

Advance Care Planning Advance care planning has been defined as ‘a process of discussion between an individual, their care providers, and often those close to them, about future care’ (Royal College of Physicians, 2009). A voluntary process which only comes into being if an individual loses the ability to make decisions for themselves or ability to communicate their wishes to others. Person centred If they lose capacity, there is a ‘best interest’ tool

Components of an ACP Making a will Putting your house in order Statement of wishes & care preferences Putting your house in order Planning your funeral Advance decision making ACP consists of all of these but some people might only look at one or more of these areas…

Communication of statement of wishes, preferences, beliefs and values Reflects individual’s aspirations & preferences or general beliefs & aspects of life they value Helps staff in identifying how clients wish to be cared Can help if there is a need to act in the ‘best interest’ of the client ACP usually involves discussions about values and or preferences for treatment. The first of these is usually referred to as a Statement. This identifies what is important to the person. They may have personal goals for care that they would wish to be continued or undertaken if they lacked capacity, for example, having someone to sit with them or read to them. The statement is a written record, not legally binding. Under MCA part of assessing best interests is finding out what a persons wishes, preferences, values and beliefs might be. Asking family or care providers and reading statements. In Glos. we now have a best interests document for those with advanced dementia. Show a copy.

Advance decision to refuse treatment ‘a decision you can make to refuse a specific medical treatment in whatever circumstances you specify’ Over age 18yrs Must have mental capacity Written or verbal Must be written/signed and witnessed if it includes a refusal of life sustaining treatment Should be guided by a professional with appropriate knowledge Only becomes active when patient loses capacity Applies only to a refusal of a treatment Used to be known as a living will/advance directive If someone doesn’t have mental capacity, a Best Interest discussion is implemented. (another Glos tool) Who are the professionals that could guide the patient? GP, Consultant, CNS, Advanced practitioner, Hospice Nobody can demand a treatment

What treatments might be refused? Call out Eg. Antibiotics, Resus. food, treatments to prolong life (eg. Chemo) But must be specific and related to the presenting condition.

Advance decision to refuse treatment An advance decision must relate to a specific treatment and specific circumstances Must be in writing, signed and witnessed and state that it is to apply even if life is at risk Legally binding if valid and applicable to the circumstances Its not valid if.. If it is withdrawn by the individual who made it A Lasting Power of Attorney has been created subsequent to the advance decision The individual has done anything that is inconsistent with the advance decision. Does not apply to the specifically stated circumstances (Consideration may be given to long lapses of time during which medical treatment advances have been made.)

When is an ACP likely to be used? Following a life limiting diagnosis Deterioration or significant shift in treatment focus Life changing event – death of spouse During assessment of individuals needs In case the unexpected happens Future planning Examples only Important not to plan too early! Can change their minds..

The Gloucestershire tool… The Gloucestershire tool…. Planning for Your Future Care (Advance Care Planning) Emphasise it is a person held document, not a clinical record.

What is included in the ACP document? Statement of your wishes and care preferences Advance decision making Putting affairs in order Making a Will Funeral planning Hand out a copy of the ACP document and the introductory leaflet to each participant The smaller Information leaflet which can be a more gentle way of introducing the concept and the larger document.

Opportunities for the practice nurse and the surgery How and when might you be able to introduce ACP discussions and resources What are the challenges? They may run the following clinics.. COPD Diabetes Dementia CKD The documents could be displayed in information racks/tables within the surgery. Could they be included within the nurse led clinic information? 13

End of Life Care Worker within a GP practice Looking for PN who would like to become a link worker Contact sue.goold@nhs.net for a visit who can explain more Lets take this forward and explore your role in EoLC Aim to have a link in each practice Visit each area ?form a group Invited to attend Care services special interest group

Further training See ‘Calendar of Events’ via www.gloucestershireccg.nhs.uk/your-serviceseolc/eolc-training/ or contact your local hospice. ACP Workbook available on above website E learning, e-elca www.e-elca.org.uk Shadowing other staff EoLC Forums at each hospice Personal reflection Where to get copies of ACP Document Suggest making the web pages and Calendar of events as ‘favourites’ on computer. Explain what e ELCA sessions are – over 156 free e learning sessions that all relate to end of life care. Excellent resource if able to access. There are some free ones available for the Public- just give it a go! Handout: Give out a bookmark- shows the website and the Forums Handout: how to order EoLC resources

References & Resources The Six Ambitions for Palliative and End of life care: Department of health 2015 Advanced Decisions to Refuse Treatment, Department of Health 2008. The National Council for Palliative Care End Of Life Care Strategy Department of Health 2008.. Preferred Priorities for Care tool, www.endoflifecareforadults.nhs.uk The Gold Standards Framework www.goldstandardsframework.org.uk Difficult conversations, communication with people with COPD National Council for Palliative Care (2010) Starting end of life care conversations with people affected by Dementia. www.dyingmatters.org Support Sheets 13, 18 End of Life Care Programme – Also 2gether Trust: My end of Life Plan and What I want to happen booklet For Learning disabilities