Advance care planning: thinking, talking and planning end of life care

Purpose of the consultation To provide information about The patient context The history The process The benefits The challenges The future developments

The patient context Could be anyone with an interest in planning their future health needs Current focus is on those who meet agreed indicators e.g. – With a terminal or chronic progressive illness – Expected to be in their last year of life

The history National ACP Cooperative formed June’10 by clinicians and care providers. Several goals incl. engaging community, training health workers, supporting clinicians, developing consistent documentation. Legal framework: Code of Health and Disability Services Consumers’ Rights 1996 (the Code of Rights) and the Protection of Personal and Property Rights Act 1988 (The PPPR Act) Good level of ‘in principle’ support from Canterbury Clinicians in primary & secondary care

The process Suitable competent patient identified (criteria) Facilitator or clinician discusses information available about ACP Patient expresses interest Facilitator or clinician discusses content of plan (probably reflection time after this) Plan completed and made available (system availability under discussion) Patient deteriorates in accordance with plan and plan implemented – subject to final direction of clinician

The benefits More patient choice in ‘end of life’ care Creation of shared understanding in the relationship Patient’s plan continues to speak for them when they are no longer competent to do so Reduction in burden for family/whanau and clinicians around choices of care Reduction in undesired interventions for the patient Not set in stone – able to reviewed, changed or cancelled by patient

The challenges Documentation – overcome, “My ACP” live and will be reviewed after a trial period Time & funding – under consideration Skills – Training is being arranged Resources - andhttp://ci.streamliners.co.nz Healthinfo.org.nz

Future developments Other consultative groups to ‘spread the word’ incl groups of clinicians Identify and recommend most appropriate IT system for plans to be accessed (work underway) Identification of funding mechanisms for GPs Holding workshops and training courses