1. Who should be encouraged to have conversations? 1.People at risk of deteriorating health in the future These are people who have: One or more advanced / life-limiting long term condition Physical and or mental health problems that are likely to deteriorate in the future 2.Peoples who health is now deteriorating with one or more advanced conditions 3.People who are now dying (in the last days of life) or at a high risk of dying soon

2. Talking about ‘What Matters’ What do you know? What are you expecting? What’s happening? What matters? What would help? Future Care Planning 1. Advance care planning (ACP) ‘When and if’ plans 2. Anticipatory care planning (AnCP) ‘What to do if’ plans 3. Final days of life planning ‘What matters now’ plans Plan the discussion Key people (‘who matters to you’) What matters to you Urgency of situation/ speed of deterioration Capacity for decision-making Information about previous planning Understanding / readiness How can we help?

4. Anticipatory care planning (AnCP) What to do if plan In-conjunction with clinicians for what to do when health deteriorates, What's and who's important, Managing uncertainty & emergency care plan in case situation changes suddenly, Plan A & Plan B May include DNACPR discussions

5. Dying Matters

6. http://opinionator.blogs.nytimes.com/2015/11/18/pitfalls-for-proxies/