end of life care: advance care planning

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End of Life Care: Advance Care Planning

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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. - PowerPoint PPT Presentation

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Page 1: End of Life Care: Advance Care Planning

End of Life Care:Advance Care Planning

Page 2: 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

Page 3: End of Life Care: Advance Care Planning

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

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Advance Care Planning

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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?

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End of Life Strategy (2008)

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

Page 7: End of Life Care: Advance Care Planning

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

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• 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

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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)

Page 10: End of Life Care: Advance Care Planning

Relevant Documentshttp://www.endoflifecareforadults.nhs.uk/eolc/acp.htm

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ActivitySplit into 4 groups and take 15 minutes to

discuss the following:

1.In what situations in your practice may an individual wish to consider ACP?

2.What considerations need to be taken into account when initiating a ACP discussion?

3.What are the benefits and challenges that ACP presents

Page 12: End of Life Care: Advance Care Planning

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

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Considerations that need to be taken into account when initiating an

ACP discussion

• Voluntary• Respect that 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?

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• Be preparedP- prepare for the discussionR- 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

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• 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.

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• 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

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What are the benefits and challenges?

Client centred approach

Choices

Empowerment

Communication

Confidence

Documentation

Hope

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National End of Life Programme

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Terms used within ACP

What do you understand by the following terms?

• Advance Statement

• Advance Decision

• Lasting Power of Attorney

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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

Page 21: End of Life Care: Advance Care Planning

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.

Page 22: End of Life Care: Advance Care Planning

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

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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 medical treatment advances have been made.)

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Relevant Documentation

http://www.endoflifecareforadults.nhs.uk/eolc/acpadrt.htmlevant

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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

Page 26: End of Life Care: Advance Care Planning

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)

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ReferencesDepartment 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 http://www.e-lfh.org.uk/projects/e-elca/index.html

Henry, C. & Seymour (2008) Advance Care Planning: A guide for health and social care staff, Department of Health, accessed on 31/08/2010

http://www.ncpc.org.uk/download/publications/AdvanceCarePlanning.pdf

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.

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Resources

• Advanced Care Planning- www.endoflifecare.nhs.uk• Advance Decisions to Refuse Treatment- A guide for

Health and Social Care Professionals- www.endoflifecareforadults.nhs.uk

• Good Decision Making-The Mental Capacity Act and End of Life Care- www.ncpc.org.uk

• National End of Life Care Strategy-www.dh.gov.uk/publications

• Planning for your Future-A Guide- www.ncpc.org.uk• Preferred Priorities for Care-www.endoflifecare.nhs.uk

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• Any questions?