Palliative care emphasises advance care planning. It helps patients and their families to:
- Consider the kind of care that fits with their values
- Make decisions about future care, and review possible scenarios in relation to their own situation and their values
- Identify a proxy decision maker, if one is available and appropriate
- Discuss organ donation, wills, funerals, and other matters related to the end of life.
Written information about a patient’s wishes may need to be available for emergencies, and for when a patient is transferred between different settings of care. Ensuring this happens is part of the advance care planning process.
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TIP - Advance care planning simply involves discussing a person’s wishes and ensuring that the family or other proxy decision-maker is aware of these wishes. Make sure they are noted in the clinical record.
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Disease specific considerations
Patients often need information relevant to their own condition, given sensitively, to help make decisions about treatment choices and care arrangements.
For detailed discussion of the options for palliation when patients have very specific concerns (for instance fears about pain, dyspnoea, or other aspects of their illness) a specialist palliative care referral may be helpful.
Legal considerations
Advance care planning processes vary greatly between states and territories. Some shared concepts underpin the process:
- Advance directive
Instructions that consent to, or refuse, defined treatments in the future which come into effect when the person can longer make decisions.
- Decision-making capacity
Relates to whether a patient understands the implications of a particular treatment choice when the decision is made. Decision-making is context specific – a patient may be able to make some decisions and not others. Depression and cognitive function are important considerations.
- Enduring power of guardianship / medical power of attorney
A person may legally appoint someone as an enduring guardian or enduring medical power of attorney to make their health care decisions if they are incapacitated.
If there is any risk of conflict with the next of kin or another relative, or if the patient is concerned that their wishes may not be respected, referral for appropriate advice is important. Social workers in palliative care services or hospitals usually have considerable experience in this area.
Reviewing advance care plans
Advance care plans should be regularly reviewed as situations change.
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This page was created on 26 May 2009 and is due for review in May 2011.