CHESHIRE & MERSEYSIDE PALLIATIVE AND END OF LIFE CLINICAL NETWORK

ADVANCE CARE PLANNING FRAMEWORK PROMOTING CONVERSATIONS AND PLANNING YOUR FUTURE CARE

What is ACP?

Process for planning for future health and personal careBeliefs and preferences used to guide clinical decision making in future when person unable to make / communicate themVerbal or writtenStrengthened if written

Who is ACP for?

Frail elderlyPeople of any age with chronic progressive and life-limiting conditionsPeople approaching end of lifePeople with multiple co-morbidities and /or at risk of stroke or heart failurePeople with early cognitive impairment

Why do ACP?

1. Deliver patient centred care

•Enabled to make decisions regarding their own careReduces anxiety / Improve QoL / improve chronic disease managementPeople engaged with decisions more satisfied with their careReduce unwanted / unnecessary treatment

Why do ACP?2. Caring for an ageing population

Over 70 years more likely admitted to hospital with multiple co-morbidities including dementiaComplex needs with decision making needed from wide group of specialistsMany older people have limited decision making capacity before they dieElderly often do not want life prolonging treatments if no realistic expectation of recovery

What do people want at End Of Life?

Symptoms managedAvoid prolongation of dyingAchieving a sense of controlRelieving burdens placed on familiesStrengthening relationships

Singer et al 1998; Steinhauser et al 2000

In the 21st century, people are living longer, ageing further and dying slower, with more degenerative disease, than ever before. The medicalization of death has resulted in us

dying away from home, in relative isolation, often in a hospital where the first priority is to prevent death. We face an increasingly degenerative end to life with less and less

control over our dying process.

GUY BROWN. AUTHOR OF ‘THE LIVING END’COMPASSION IN DYING TRUSTEE

82% people have strong views about EOL care

48% wrongly believe legal

right to decide to make treatment

decisions 22% don’t

know

9% GPs not heard of ADRT

4% refused to sign ADRT

validity/payment

4%have ADRT

You Gov / Compassion in Dying Survey 2013

Cheshire & Merseyside

Network

• 12 months to develop ACP framework

• Clinical lead Palliative Medicine Consultant

• Scoping / literature review• Project management group

– Multi-disciplinary- All areas- 3 Patient representatives

• Clear governance structure

Network ACP project

• Agree principles and working definitions

• Make recommendations on utility of identification tools

• Make recommendations to promote discussions of ACP among wider public

• Make recommendations regarding development of systems for transfer of information

• Recommendations of educational models

• Recommendations on assessment of ACP process

Network ACP ProjectObjectives

Future care planning

Definition of the ACP process

Statement of wishes, beliefs &

prefences

Future Care planning

Statement of wishes, beliefs &

preferences

Named person to speak on

behalf

INFORMAL

Do Not Attempt

Resuscitation

Definition of the ACP process

INFORMAL FORMAL

Do Not Attempt

Resuscitation

Clinical Management

Plan

Statement of wishes, beliefs &

preferences

Named person to speak on

behalf

Appoint someone to make

decisions

Future care planning

Advance Decision to

Refuse Treatment

Definition of the ACP process

Do Not Attempt

Resuscitation

Clinical Management

Plan

CLINICAL

Future Care planning

Statement of wishes, beliefs &

preferences

Named person to speak on

behalf

INFORMAL Advance Decision to

Refuse Treatment

FORMAL

Appoint someone to

make decisions

Definition of the ACP process

Electronic Palliative Care Co-ordination Systems (EPaCCS)

Future Care planning

Statement of wishes, beliefs &

preferences

Named person to speak on

behalf

INFORMAL FORMAL

Do Not Attempt

Resuscitation

Clinical Management

Plan

CLINICAL

Appoint someone to

make decisions

Advance Decision to

Refuse Treatment

Do Not Attempt

Resuscitation

Clinical Management

Plan

CLINICAL

ADVANCE CARE PLANNING

ANTICIPATORY CLINICAL PLANNING

ADVANCE CARE PLANNING

ANTICIPATORY CLINICAL PLANNING

ADVANCE CARE PLANNING

BEST INTEREST DECISION

• Agree principles and working definitions

• Make recommendations on utility of identification tools

• Make recommendations to promote discussions of ACP among wider public

• Make recommendations regarding development of systems for transfer of information

• Recommendations of educational models

• Recommendations on assessment of ACP process

Achieved

Way forward

• Framework and all forms available at:www.cmscnsenate.nhs.uk

• Disseminate network wide

• Local Implementation plans