End of Life Care: Advance Care Planning. Confidentiality Shared learning One at a time Respect one another’s opinions Positive critique Sensitivity Time-out Mobile phones/pagers off please Any more?. Ground Rules. Learning Outcomes.
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By the end of the programme the practitioner will be able to:
Develop their knowledge and understanding of the concepts of Advance Care Planning and the Liverpool Care Pathway and their application to practice
What do you understand by the term advance care planning?
What is the difference between advance care planning and care planning?
How many of you have been involved in Advance Care Planning?
“All people approaching the end of life need to have their needs assessed and their wishes and preferences discussed.”
Concern’s and wishes
Values and goals of care
Understanding of their illness and prognosis
Preferences for care or treatment that may be beneficial in the future and the availability of these
And usually takes place in anticipation of a deterioration in a person’s condition in the future where they are not able to make decisions and/or communicate their wishes
ACP is undertaken in the context of an anticipated deterioration in the individual’s condition with the attendant loss of capacity to make or communicate decisions
Killick et al.(2010)
Split into 4 groups and take 15 minutes to discuss the following:
Life changing event – death of spouse
Following a life threatening diagnosis
Deterioration or significant shift in treatment focus
During assessment of individuals needs
Following multiple hospital admissions
In case the unexpected happens
Respectthat the client may not wish to confront future issues
Client Centred Dialogue
? Family/ carer involvement in discussion.
Who is the most appropriate to carry out this discussion?
P- prepare for the discussion
R- relate to the person
E- elicit pt and carer preferences
P- provide information
A- acknowledge emotions and concerns
R- realistic hope
E- encourage questions
Knowledge of support, services and choices available in the particular circumstances.
The professional must have adequate knowledge of the benefits, harms and risks associated with treatment for client to make informed choice.
Client has the Capacity to understand, discuss options available and agree to what is then planned
Client centred approach
What do you understand by the following terms?
Lasting Power of Attorney
Not legally binding
A written record
Reflects individual’s aspirations and preferences or general beliefs and 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
Used to be called Advance Directive / Living Will
An advance decision must relate to a specific treatment and specific circumstances
Legally binding if valid and applicable to the circumstances
It only comes into effect when the individual has lost the capacity to give or refuse consent.
‘a decision you can make to refuse a specific medical treatment in whatever circumstances you specify’
Over age 18yr, has 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
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 medicaltreatment advances have been made.)
Advance Care Plans must meet the requirements of the Mental Capacity Act (MCA).
Assumed to have capacity
Supported to make own decisions, even if it is unwise
Least restrictive of their rights and freedom
The Law Society (2010)
Department of Health (2008) End of Life Care Strategy. London: DH
Department of Health (2010) End of Life Care for All (e-ELCA), accessed on 01/12/2010 http://www.e-lfh.org.uk/projects/e-elca/index.html
Henry, C. & Seymour (2008) Advance Care Planning: A guide for health and social care staff, Department of Health, accessed on 31/08/2010
Killick, S., Pharaoh, A. & Randall, F. (2010) Advance care planning in care homes, Palliative Medicine, Vol 24, No 4, pp. 445-446.
The Law Society (2010) Assessment of Mental Capacity, Capacity to consent to and refuse medical treatment and procedures., Chapter 13, 3rd edition pp. 130-131.
NHS Gloucestershire (2010) Planning for Your Future Care, Advance Care Planning.
Advanced Care Planning- www.endoflifecare.nhs.uk
Advance Decisions to Refuse Treatment- A guide for Health and Social Care Professionals- www.endoflifecareforadults.nhs.uk
Good Decision Making-The Mental Capacity Act and End of Life Care- www.ncpc.org.uk
National End of Life Care Strategy-www.dh.gov.uk/publications
Planning for your Future-A Guide- www.ncpc.org.uk
Preferred Priorities for Care-www.endoflifecare.nhs.uk