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Advance care planning
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Who’s who?
Background to Advanced Care Planning
Hilary Squire
Clinical Nurse Specialist
Hospiscare
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References
• The cancer Plan (DoH, 2000).
• The Cancer Reform Strategy(DoH, 2007).
• Advanced Care Planning: A guide for Health & Social Care Staff (2007) at: http//www.endoflifecareforadults.nhs.uk
• The End of Life Strategy (DoH, 2008).
• Dying Matters Coalition GP Project NCPC (2010) at http//www.dyingmatters.org
Strategies in Instigating an ACP
Annie Hunneyball
Clinical Nurse Specialist
Hospiscare
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High
Low
Fun
ctio
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Time
Cancer
High
Low
Fun
ctio
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Time
Fraility/Dementia
High
Low
Fun
ctio
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Time
Organ Failure
GP’s Workload
Ave 20 Deaths per GP per year
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References
• Advance Care Planning: A guide for Health & Social Care Staff (2007) at :http// www.endoflifecareforadults.nhs.uk
• Gold Standard Framework Prognostic Indicator Guidance (2008) at: http//www.goldstandardsframework.nhs.uk
• The End of Life Strategy (2008) Department of Health, at: http//www.DoH.gov.uk
ADVANCED CARE PLANNINGCaroline Prince
Clinical nurse specialist
Hospiscare
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Advance Decision to Refuse Treatment
Dr Jane WhitehurstMacmillan GP Facilitator for Exeter and Mid Devon
Specialty Doctor Hospiscare
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Valid ADRT
• I now have MND and benefit from PEG feeding. As my condition deteriorates, if I should lose consciousness and am not expected to recover after 24hrs, I wish feeding, hydration and any other life prolonging treatment such as antibiotics to be withdrawn or withheld although medication such as painkillers for my immediate comfort can be used. This decision to apply even if my life is at risk”
Valid ADRTs
I wish to refuse the following
specific treatments:-
In these circumstances:-
Artificial (mechanical) breathing
machine
If I have had a severe stroke with
little chance of recovering
consciousness
Antibiotics If my dementia means that I cannot
not make the decision, in the event
that I have a severe chest infection
that might threaten my life.
Artificial feeding (via a tube or drip) When my dementia has
deteriorated to the point that I
cannot swallow safely, even with
the help of others
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Core Competencies for ACP
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Last night, my husband and I were sitting in the
living room and I said to him, 'I never want to live in
a vegetative state, dependent on some machine
and fluids from a bottle’.
He got up, unplugged the computer, and threw out my
wine.
Mrs Adams
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Mr Brown
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Mrs Carter
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Mr Downham
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This is my favorite recipe. It was Granny's. Now you are the
guardian
“This is a book that I am really going to miss. Think of me
whenever you read it
Here is my favourite joke. Dad left it to me, now you must keep it alive
Thank you for this memory. I treasure it.
I always wanted to tell you this but was too shy/afraid/embarrassed.
I can’t remember if I told you this before but.....
There is something I have learned that I would like you to know
If you watch this film, think of me. It was my favourite.
Have you ever thought about trying....I reckon you would be
great at it
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