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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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Presentation Transcript
ground rules

Shared learning

One at a time

Respect one another’s opinions

Positive critique



Mobile phones/pagers off please

Any more?........

Ground Rules
learning outcomes
Learning Outcomes

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

advance care planning acp
Advance Care Planning (ACP)

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?

end of life strategy 2008
End of Life Strategy (2008)

“All people approaching the end of life need to have their needs assessed and their wishes and preferences discussed.”

advance care planning1
Advance Care Planning
  • A process of discussion between the individual and their care providers, irrespective of discipline.
  • Family/carers may be included if the individual wishes.
  • It is a voluntary process.
  • It is recommended that with the individual’s agreement this discussion is documented, regularly reviewed, and communicated to key persons involved in their care.
  • County-wide ACP Document – ‘Planning for Your Future Care’
  • The document is held by the individual
The discussion may include the individual’s

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

why is acp different to other planning
Why is ACP different to other planning

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)

relevant documents
Relevant Documents


Split into 4 groups and take 15 minutes to discuss the following:

  • In what situations in your practice may an individual wish to consider ACP?
  • What considerations need to be taken into account when initiating a ACP discussion?
  • What are the benefits and challenges that ACP presents
situations in which an individual may want to consider acp
Situations in which an individual may want to consider ACP

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

Future planning

considerations that need to be taken into account when initiating an acp discussion
Considerations that need to be taken into account when initiating an ACP discussion


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?


Be prepared

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

D- document

  • Know our own limitations and who to go to for advice or refer on

Appropriate communication skills

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.


Choice of place of care and how that may influence treatment options

Client has the Capacity to understand, discuss options available and agree to what is then planned

what are the benefits and challenges
What are the benefits and challenges?

Client centred approach







terms used within acp
Terms used within ACP

What do you understand by the following terms?

Advance Statement

Advance Decision

Lasting Power of Attorney

advance statement
Advance Statement

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

advance decision
Advance Decision

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.

advance decisions to refuse treatment
Advance Decisions to Refuse Treatment

‘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

it is not valid
It is not valid …..

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.)

relevant documentation
Relevant Documentation

advance care planning and the mental capacity act 2005
Advance Care Planning and the Mental Capacity Act (2005)

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

Best interests

Least restrictive of their rights and freedom

lasting power of attorney lpa
Lasting Power of Attorney (LPA)

LPA’s can

  • Cover health and welfare decisions
  • Be registered at any time and MUST be registered before they are used
  • Attorney’s acting under LPA act in accordance with the principles of Mental Capacity Code of Practice.

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

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-

Advance Decisions to Refuse Treatment- A guide for Health and Social Care Professionals-

Good Decision Making-The Mental Capacity Act and End of Life Care-

National End of Life Care

Planning for your Future-A Guide-

Preferred Priorities for