6 - end of life: Advanced Care Planning Flashcards
when is planning care in advance used?
- drawn up when you can
- to be used when you might not be able to think/articulate it
- can enable autonomy to be respected even when you can’t articulate it
what is advanced care planning?
= a structured discussion with patients and their families or carers about their wishes and thoughts for the future
= a key means of improving care for people nearing the end of life and of enabling better planning and provision of care, to help them live and die in the place and the manner of their choosing
why is advanced care planning done?
what key points are usually covered in advanced care planning?
- beliefs and values
- hopes and fears
- involvement and wishes of relatives, carers and friends
- religious and spiritual needs
- wills, funeral arrangements
- organ and tissue donation
- palliative care
- specific treatments such as Clinically Assisted Hydration and Nutrition, ventilation
- place of care
- specifying wishes about treatment — Advanced Decisions, Advanced Statements, DNACPR decisions, Allow Natural Death
- lasting power attorney
what are the barriers to advanced care planning?
> perceived or actual lack of skills or knowledge
difficult conversations, potentially emotive and technical
resources — time
logistics — meeting with relatives/friends/carers, sharing information, fragmented multidisciplinary teams
inequality, access, bias
delegated decisions
capacity
best interests decisions
difficult cases — those who don’t wish to know, family conflict, children
what legal documents are there enabling autonomy at the end of life?
- advanced decision to refuse treatment - what you dont want
- advanced statement - what you would like
- lasting power of attorney - who else could decide?
what is an advanced decision to refuse treatment (ADRT)?
- a decision you can make now to refuse a specific type of treatment at some point in the future
- it lets your family, carers and health professionals know whether you want to refuse specific treatments in the future
- this means they will know your wishes if you are unable to make or communicate those decisions yourself
- a valid ADRT is legally binding
what are common contents of ADRT?
- CPR (can back up with DNACPR form)
- blood transfusions, transplants (not only Jehovah’s Witnesses)
- hospital admissions
- ITU, ventilators, NG tubes — ‘extreme measures’
when may an advanced decision only be considered?
is an advance statement legally binding?
no
what is an advance statement?
- a written statement that sets down your preferences, wishes, beliefs and values regarding your future care
—> the aim is to provide a guide to anyone who might have to make decisions in your best interest if you have lost the capacity to make decisions or to communicate them
what is a lasting power of attorney for health and care decisions?
—> just as we are allowed to nominate someone to control your finances if you cannot, you can also nominate someone to make your healthcare decisions for you
—> attorneys for financial decisions and health and care decisions are nominated on different documents and need to be applied for separately
—> enables you to choose someone else to make your decisions for you when you are not able to do so yourself — and gives them the LEGAL RIGHT to do so
—> similar considerations to ADRT in terms of patient capacity at the time
do you have a right to demand treatment?
you cannot demand a treatment that is not appropriate, not available on the NHS, futile treatments etc
