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Continuity Community and Sharing

Continuity Community and Sharing. Continuity, Community and Sharing. Increasing numbers of elderly people living with long term progressive health conditions, frailty, cognitive impairment and with variable support from family, friends and carers. Will further tests or investigations help?.

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Continuity Community and Sharing

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  1. Continuity Community and Sharing

  2. Continuity, Community and Sharing Increasing numbers of elderly people living with long term progressive health conditions, frailty, cognitive impairment and with variable support from family, friends and carers. Will further tests or investigations help? How safe is this person at home? If there is a sudden deterioration, what plans are in place? What additional care might they accept and might be available?

  3. What gets in the way? It would be a whole lot easier if she’d just accept a care package This is my 3rd visit to Mrs B this week – what am I going to do? Got to be quick as my GP surgery starts in 15 minutes I hope her daughter is not here – she is scary I’ve already admitted 3 people to hospital today – can’t possibly send in another

  4. What gets in the way? I wish it was the female doctor visiting today He had better not talk about that blasted red resuscitation form again I was hoping my daughter would be here when the doctor arrived I wonder if he has spoken with my nurse, as I told her everything Why lunchtime? My soup will be cold by the time I’m finished here

  5. Consequences of getting it wrong Guilt Suffering Grief Familyconflict Erosion of trust Anxiety Frustration Wasted resources Regret Failure Lord, Livingstone and Cooper. University College London ‘A systematic review of barriers and facilitators to and interventions for proxy decision-making by family carers of people with dementia’ International Psychogeriatrics (2015) 27:8

  6. Factors to consider Beliefs, Values, Preferences Quality of life Burden of treatment Location of treatment Potential benefits and harms Capacity to decide Consequences of doing nothing Options available Support available at home Timing of decision Impact on others Power of attorney

  7. Barriers and Facilitators Health Professional: - communications skills - knowledge - socio demographic factors - experience - attitudes Person: - medical knowledge - previous decision making experience - acceptance of illness - relationship with family - understanding of ACP System: - private room - continuity - time available - home setting

  8. Decision Making Tools NICE Patient Decision Aid Statins: Nov 2014

  9. Decision Aids towards End of Life • Systematic reviews conclude: • Tools most useful when: • there is not one clear option • treatment pathway is highly dependent on individual’s preferences and values • People often require more detailed information about prognosis to make decisions • Care preferences may change as death approaches • Decision aids can improve satisfaction levels and reduce regret

  10. Tools to support Anticipatory Care Planning

  11. Decision Making Tools

  12. Most important tools for SDM

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