1. Advanced Care Planning
Dr Jacky Payne
Balmore Park Surgery

3. 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

4. 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

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

6. 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

7. 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

8. 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

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

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

11. 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

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