Mr Kim Greeve
Project Officer
WA Cancer and Palliative Care Network
Department of Health
Western Australia
Advance Care Planning
A step-by-step guide for health care professionals
the Western Australia Experience
E-Poster
Purpose of this E-Poster
To inform WA Health of work undertaken, in developing a resource
to guide health professionals in having Advance Care Planning
Discussions.
Background
Introduction of, Acts Amendment (Consent to Medical Treatment)
Act 2008. As a result two legal powers became available:
• Advance Health Directive (AHD)
• Enduring Power of Guardianship (EPG)
There is a lack of uptake of Advance Health
Directives (AHD) legislation nationally.
Advance Care Planning is a way of addressing
this issue.
Our Aim
To promote Advance Care Planning (ACP) and improve the
incidents of ACP discussions between health care professionals and
consumers/patients.
To promote Advance Care Planning (ACP)
where the focus is on good care planning
as an essential component of clinical
practice.
Advance Care Planning
Advance Care Planning (ACP) is a process of making decisions
about future health care for patients in consultation with
clinicians, family members and important others. It aims to
ensure patients wishes are respected if they lose decisional
capacity.
(Scott, Mitchell et al)
ACP may include completing:
• Advance Health Directive
• Enduring Power of Guardianship
• Common Law Directive “Living Will”
• Advance Care Plan
Reference Group Established
The Role of the reference group in addition to providing
leadership was to determine barriers and identify those people
who could be amenable to Advance Care Planning discussions.
Provide
Leadership
Patients often wait for their doctor to initiate an ACP discussion.
Triggers
&
Prompts
Triggers, Prompts, Clinical
Indicators
• Clinicians often wait for their patient or family members to initiate an
ACP discussion.
• General practitioners often wait for a signal from the patient’s
specialist before initiating an ACP discussion. (Scott, Mitchell et al)
Triggers, Prompts,
Clinical Indicators
Health care professionals, therefore, need a way of indentifying those
patients who may benefit from ACP discussions. Our resource
provides a list of triggers, prompts and clinical indicators to assist
health professionals with identifying patients who may benefit from
an ACP discussion.
Triggers, Prompts,
Clinical Indicators
Triggers
Would you be surprised if your patient died in the
next 12 months?
Prompts
Your patient or their family asks questions, make
statements such as:
Triggers and Prompts
Clinical Indicators
Disease Specific Clinical Indicators
Our resource also provides evidence based clinical indicators for the following:
Renal disease
Heart failure
Neurological disease
Chronic lung condition
Cancer
and generic clinical indicators
Clinical
Indicators
Clinical Indicators
Generic Clinical Indicators
Clinical
Indicators
Initiating A Discussion
Our resource also provides guidance with undertaking an ACP
discussion. Such discussions can then be documented, for example,
within: Advance Care Plan; AHD/EPG/EPA; NFR orders,
Documented summary of ACP discussions within the medical
record and Amending care plans.
Health Professionals
identifying Patients, initiating and documenting discussions.
Resources Developed
They don’t stand alone
www.health.wa.gov.au/advancehealthdirective
What’s Next ?
Staff
• Training staff in – initiating ACP discussions
• Online resources
• Pilot
General Public
• Patient guide (which includes an ACP form)
• Brochure
• Online resources
Thankyou
Kim Greeve
Kim.greeve@health.wa.gov.au
Tel: +61 8 9222 0256
References
Scott IA, Mitchell GK, Raymond EJ, Daly MP. Difficult but necessary conversations –
the case for advance care planning. MJA. 18 Nov 2013; 199 (10) : 662-666.