(W3/4) ACP

Question 1

What are the communication skills required in palliative care?

Answer 1

• Active listening
• Summarising
• Paraphrasing
• Empathy
• Clarifying
• Silence
• Acknowledgement
• Encouragement

Question 2

What is the SPIKES protocol?

Answer 2

• For sharing bad news, gather info from px and family and provide support

Setting
Perception (Ask what they know)
Invitation (permission to give info)
Knowledge (Share info)
Emotions/Empathy (respond to them)
Summary/Strategy

Question 3

What is Advance Care Planning?

Answer 3

• DISCUSSION on future health and personal care in context to px values and goals
  ~ Not a legal document
• Determines substitute decision maker
• Exercises px autonomy

Question 4

What are the 3 approaches of ACP?

Answer 4

1) General : For Early onset and medically stable patient
- Identify spokesperson
- Consider goals of treatment should serious neurological injury occur

2) Disease-specific (DSACP) : Px with progressive, life-limiting illnesses w frequent complications
- Determine goals of treatment as complication escalates

3) Preferred Plan of Care (PPC) : Px w < 12 months prognosis or req long-term institutional care
- Establish specific plan of care for when px deteriorates

Question 5

What are the key components of ACP discussion?

Answer 5

• Understanding health condition
• Discussing QOL
• Naming decision-maker
• Religious/spiritual belief
• Resuscitation or life support measures
• Preferred place of care
• Preferred place of death

Question 6

What are the requirements for ACP discussions?

Answer 6

• Px has adequate mental capacity and no mood disorders
• Px is comfortable and sensory impairment is optimised

Question 7

What are the barriers of initiating ACP?

Answer 7

1) Patient factors
- Denial/unclear of diagnosis
- Inclined to protect family
- Low health literacy
- Death topic avoidance

2) Clinician factors
- Not enough time
- Lack of continuity during care transition
- Lack of knowledge and confidence
- Unclear prognosis
- Focused on curing of disease

3) System factors
- Focus on life-sustaining care
- Ownership
- Interpretation
- Concordance

Question 8

What are the strategies to overcome patient factors?

Answer 8

• Denial/unclear diagnosis
  ~ Discuss goals of care
• Inclined to protect family
  ~ Involve family in planning
• Low health literacy
  ~ Avoid jargons
  ~ Use pictorials
• Death topic avoidance
  ~ Create more ACP awareness in the community

Question 9

What are the strategies to overcome clinician barriers?

Answer 9

• Lack of continuity during care transition
  ~ Work w other stakeholder better
• Lack of knowledge and confidence
  ~ ACP facilitator training
• Unclear prognosis
  ~ Discuss goals of care
• Focused on curing of disease
  ~ Change mindset to focusing on QOL

Question 10

What are the strategies to overcome the system barriers?

Answer 10

• Focus on life-sustaining care
  ~ Focus on QOL in goals of care discussion
• Interpretation
  ~ Interpret context correctly
• Concordance
  ~ Advocate for achieving px’s goals

Question 11

ACP vs LPA vs AMD?

Answer 11

• LPA can choose how to execute decisions for px on finances/assets and care when incapacitated by non-lifesaving treatments and wishes in the ACP
• AMD for life saving treatment, and is decided by the px
• ACP to discuss broad wishes and is not legally binding