Before you start having ACP conversations with your patients, you need to know what ACP is and who would benefit from it.
It's also a good idea to have completed your own Advance Care Planning so you know what's involved, what it feels like, and what benefit you got from doing it.
Advance Care Planning is for everyone, but how you raise it may well be different depending on who you are talking to. Our research found that people are thinking about it and touching on it in casual conversation, but most don’t know their preferences can make a difference and influence their own outcomes. There was also a clear message that they want their clinician to bring it up in conversation.
For a better understanding of this, you should do the eLearning module Talking About ACP and take a look at the SPICT guideline.
Think about these different opportunities and how you could raise it with patients at difference stages of their lives:At a minimum, you need to be ready to respond to a patient who raises it with you. It is also expected that you would raise it with patients who are approaching the end of their lives, to find out what’s important to them and help give them some control over what might happen.
Advance Care Planning is not a one-off conversation. It’s a series of conversations between your patient, you, their family/whānau
and any important others. Your purpose is to find out what’s important to your patient, how their beliefs and values might affect any
future medical treatment and care they need, and how they’d like decisions made if they’re unable to speak for themselves.
Ideally these conversations will lead up to a written statement of their preferences for health care and end of life care, with any specific directives, so that it can be referred to if and when needed.
There may be barriers to talking about and planning for future care - particularly care at the end of life. It is helpful to consider
these barriers from both your perspective and your patients’ perspective, so that you can achieve a positive outcome.
Here are some conversation starters you might want to try:
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There is great value in any Advance Care Planning conversations that you have with your patients, but unless these are documented it may get lost.
So whenever you have an Advance Care Planning discussion, take the time to summarise and record the key points so that it is there for you or others to refer to if needed. Let your patient know that you want to keep a note of what you’ve discussed, and confirm the key points with them.
It is even better if you can encourage them to, or assist them to, complete an Advance Care Plan. The My Advance Care Planning Plan template is useful
Once a patient has completed an Advance Care Plan:
Our patients are relying on us to use the information about what is important to them, what their values and beliefs are, and what
treatment and care they want . Not only to help make decisions when they can no longer make decisions for themselves but also to
influence the way we communicate with them, the way we work with them and the way we support them from now until they cannot speak
If you are unsure of the legal framework for decision-making, and how Advance Care Planning can change outcomes you will find the eLearning module useful.
Patients have expressed concern that their plans may be ignored if they have not been updated recently. And in reality many
clinicians reduce their reliance on previously stated preferences if some time has elapsed since they were recorded.
Many people’s values and beliefs don’t change with the passing of time. However their care and treatment preferences and plans may well need to be revisited if circumstances change, for example if they:
If patient-centric care planning is part of the way you work with your patients, their plan should already account for these changes.
If not, either: