1. Judith Bailey November 2014

2. What is advance care planning? Why consider it- the evidence What about in real life….what are the nuts and bolts? What about here and now?

3. What is Advance Care Planning ACP is a process of discussion and shared planning for future health care. It involves patient, whanau and health care professionals. ACP gives patients the opportunity to develop and express their preferences for end of life care based on:  their personal views and values  a better understanding of their current and likely future health  the treatment and care options available. DNR – evolution process

4. Why bother?

5. BMJ 2010

6. University hospital setting in Australia 309 legally competent medical inpatients aged >80 Randomised to receive usual care or usual care plus facilitated advance care planning(ACP) ACP involved: Assisting people to reflect on goals, values and beliefs Consider future medical treatment preferences To appoint a surrogate To document their wishes Carried out by trained facilitator( nurse or allied health professional) Followed for 6 months or until death

7. BMJ 2010

8. Standard plus palliative care: Fewer chose aggressive end of life care – (33 vs 54%) Higher QoL Fewer had depression – (16 vs 38%) Median survival longer – (11.6 vs 8.9 months)

9. 56 died by six months end of life wishes more likely to be known and followed family members had significantly less – stress – anxiety – depression patient and family satisfaction was higher in the intervention group. BMJ 2010

10. What about the nuts and bolts?

11. Translating what is important into treatment plans What is important to patient? Initiate Treating doctor needs to be aware of ACP Doctor needs to use the plan to inform treatment/care where appropriate 43 2 2 1 5

12. Who does advance care planning? Those who want to. Well people People with chronic disease People who are dying Our job is to offer them the opportunity-it’s all about conversation with people It’s about giving information they may want Its about being willing to talk and listen about the hard and uncertain stuff It may be about helping document what people want in ways health professionals will understand

13. Think about the last person you cared for who has died. What went well? What didn’t go so well? What future planning happen ? Did it impact on how care happened ?

14. Hard conversations-any wisdom to offer?

15. Consumer information resources:

16. What happens next? At the least record some notes of these conversations. If using the documents- Patient held record Keep a copy Make sure GP has copy Update when changes occur or annually Copy with local hospital Working with ambulance service

17. Legal overview Sits well with Code of health and disability consumer rights Advance care planning requires decision-making capacity Legal place of an advance directive Absence of capacity (Right 7(4)): –EPoA (personal welfare) –Clinician makes the decision in the patient’s best interests: Ascertain views of patient Can consider views of other suitable people

18. What about here and now? What is available and who are the people involved? Training Working in with the hospitals Ambulance services Public awareness

19. Resources www.advancecareplanning.co.nz