Advanced care planning - Palliative care, EofLC Flashcards
What is advanced care planning?
Offers people the opportunity to plan their future care and support, incl medical treatment while they have to capacity to do so e.g. dementia
What do you need to ask pts when undertaking advanced care planning?
- Ensure they are referring to specific treatments in specific circumstances
Ask pts: - How would you like to be looked after
- Any spirutual or religious beliefs you would like taken into account
- Who you want to spend time with
- Who your drs and nurses should talk to if you don’t have capacity to make decisions
What are the steps in advanced care planning?
1) THINK- about the future, what is important to you, what would you want to happen and not happen if you became unwell
2) TALK- with family and friends, ask someone to be your proxy spokesperson or Lasting power of attorney if you are no long able to speak for yourself
3) RECORD- record your thoughts as your own ACP incl your spokesperson and store this safely
4) DISCUSS- you plans with your doctor, nurses and carers, and this might incl discussion about resuscitation or refusing further treatment
5) SHARE this info with others who need to know about you, through your health records or other means and review it regularly
Who needs ACPS?
- End of life- palliative care
- People at risk of losing mental capacity e.g. progressive illness
- People who mental capacity varies at different time, e.g. through mental illness
ResPECT Form vs DNACPR
ResPECT: RECOMMENDED SUMMPART PLAN FOR EMERGENCY CARE AND TREATMENT:
* Created summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have the capacity to make or express choices
DNACPA: DO NO ATTEMPT CPE
* If heart or breathing stops, the healthcare team will not try to restart it
What is an
Advance statements?
Statement that allow individual to make general statements about their wishes, beliefs, feelings and values and how these influence their preferences for their future care and treatment
What is Advanced decisions to refuse treatment?
Legally binding docs
Its purpose is to ensure that an individual can refuse a specific treatment that they do not want to have in the future
What is lasting power of attorney?
Legal doc that lets you (the donor) appoint one or more people (attorneys) to help you make decisions or to make decisions on your behalf
What do you need to take into account in ACP?
Pts:
history
social circumstances
wishes and feelings
beliefs, including religious, cultural and ethnic factors
aspirations
any other factors they feel are important.
What communication support may the pt need during ACP?
communication aids
advocacy
interpreters
specialist speech and language therapy support
involving family members or friends.
GMC defintion of ‘approaching end of life’?
Likely to die within the next 12 months. This includes:
* patients whose death is imminent (in few hours/days)
* pts w/ advanced, progressive, incurable conditions
* general frailty and co-existing conditions that mean they are expected to die in next 12m
* pts w/ existing conditions if they are at risk of dying from a sudden acute crisis in their condition
* pts w/ life-threatening acute conditions caused by sudden catastrophic events
What ‘tools’ may be helpful in understanding a pt who is at EofL/in care home?
- Understanding their wishes
- Assessing their capacity
- Fraility evaluation (clinical fraility score)
- Understand current symptom burden
- Predict their trajectory
- Do a med review
- Construct a problem list
- Optimise long term condition management, rehab and non-pharmacological support
- ReSPECT and Adv care planning for EofL
From BB:
According to the Gold Standards framework, what 4 questions should an Advance Care Plan address?
- At this time in your life, what is important to you?
- What elements of care are important to you and what WOULD you like to happen in the future?
- What would you NOT want to happen? Is there anything that you worry about or fear happening?
- Who would speak for you - your nominated proxy spokesperson or LPA?
