Advance care planning, ADRT, DNAR, Lasting Power of Attorney Flashcards
What is a good death?
A good death considers the patient’s wishes and what is right for them. People should die in an environment they’re comfortable with, be symptoms free and surrounded by those they want around them.
The best way to know how to achieve a good death is to plan for it and discuss what patients would like early on in their disease course. It is a disservice to patients to avoid discussions about death and the dying process
What is advance care planning?
This is a voluntary discussion that identifies a person’s wishes/values, concerns and preferences for care in anticipation of future deteriorations
It is done when patients have capacity and the wishes outlined should be considered if a patient loses capacity.
When might people consider advance care planning?
Death of a spouse or friend Recurrent hospital admissions Change in care setting Diagnosis of a life limiting condition Progressing disease
What is the role of advance care planning?
Determine what a patients wants their end of life care to involve, it can be done when patients have capacity and should be considered if capacity is lost
What is included in advance care planning?
Discussion of wishes for dying process
Wishes regarding how much information should be provided
Patient should be encouraged to pick what is right for them
Lasting power of attorney discussion
Discussion about Advanced decision to refuse treatment
Making wills
Funeral planning
Organ and tissue donation
Early on discussion about DNAR.
Written information should be provided to patient as it is a lot to discuss
What is a lasting power of attorney?
Appoints someone who can make decisions regarding the care of a patient if they lose the capacity to do so themselves
Why is advanced care planning important?
It ensures the individual’s wishes are known and can be met where possible
Information can be learnt whilst patients still have capacity
Can appoint lasting powers of attorney
Discussions around advanced decision to refuse treatment and DNAR
Encourages patients and family members to reflex on priorities, wishes and aspirations early on
Encourages discussion with significant others so they know what their loved ones would want
Can identify questions or things patients want to learn which can be addressed by HCPs
Improve satisfaction and reduce uncertainty
How might you ask about advanced care planning?
If you think about the future, do you have any hopes or fears?
Thinking ahead to a time when your illness could be worse, have you thought about where you would like to be cared for?
Have you ever thought about where you would like to die?
What is an advanced statement? Is it legally binding?
This is a statement that formalises what patients do wish to happen to them. It is useful for clinicians in planning a patient’s individual care.
It is not legally binding and may also need an advanced directive and DNAR.
It is useful as it prompts discussion and early identification of priorities, it can inform decision making in the future.
What is a advanced decision to refuse treatment? Is it legally binding?
This outline what patients do not want to happen to them, made when patients have capacity.
This is a legally binding document. Must be written, signed and witnessed.
It outlines specific treatments in specific circumstances and is effective when capacity is lost.
What is a lasting power of attorney?
This is an individual who is appointed to make decisions on behalf of the patient if they patient loses their capacity.
What are the differences between an advanced statement and an advanced decision to refuse treatment?
Advanced statement is not legally binding whereas ADRT is legally binding
Advanced statement is more generally whereas ADRT outlines specific treatment in specific circumstances
Advanced statement outline what patients would like to happen, whereas an ADRT specifically outline specific treatments that are not wanted
What is a lasting power of attorney?
This is a legal document which states in writing who can make decisions for a person if they lack capacity.
This includes decisions relating to property, financial affairs, health and medical care and welfare. Decisions must be made with the patient’s best interest at heart.
Who is an independent mental capacity advocate (IMCA)?
This is for people who lack capacity but have no close family or friends, do not have an ADRT or recorded choices about their care.
This independent mental capacity advocate advocates for the person’s wishes, feelings, beliefs and values.
What does AND stand for?
Allow natural death
