8. Advanced Care Planning Flashcards
What is advance care planning (ACP)?
A voluntary process of person-centred discussion between an individual and their care providers, regarding their preferences and priorities for future care.
These discussions happen while they have the mental capacity for meaningful conversation.
What are the outcomes of advance care planning?
- advance statement
- advance decision to refuse treatment
- nomination of a Lasting Power of Attorney
- context-specific treatment recommendations
Who benefits from ACP conversations?
Any individual who wishes to plan for their future care, or who may be at increased risk of losing their mental capacity in the future.
For example:
- dementia
- declining functional status
- multiple hospital admissions
- major surgery
- life threatening conditions
What is an advance decision to refuse treatment (ADRT)?
If a patient wishes to refuse life-sustaining treatment, they can put this in writing, sign and date it in the presence of a witness.
It is legally binding if it complies with the Mental Capacity Act, is valid, and applicable.
What is an advance statement?
Allows you to make general statement, describing your wishes and preferences about future care, should you be unable to make or communicate a decision or express your preferences at the time.
What is the difference between an advanced statement and an advanced decision?
Advanced decision covers only refusals of medical treatment. Legally binding.
Advance statement covers preferences of any information you feel is important to your health or care. Not legally binding.
What is a ceiling of care?
The maximum level of care that a patient is set to receive, based on their chances of survival balanced with subjecting the patient to painful, undignified interventions.
e.g. ceiling of care being ward, ITU
What things need to be considered in an EoL management plan?
- review of polypharmacy
- take into account pt priorities
- symptom control vs curative treatment
What is medical futility?
Futile treatment is treatment that does not bring benefit to the patient in terms of quality of life, or prolongation of life.
What is age discrimination?
Person is treated less favourably because of their age.
What can be put into place to combat ageism within healthcare?
- policy and law
- education activities
- intergenerational activities
What are some life-sustaining treatments that may be withdrawn when a patient in EoL?
- feeding tubes
- dialysis
- ventilation
What are some anticipatory drugs prescribed for pain in the palliative process?
Morphine (first line) - monitor for constipation and sedation.
Alfentanyl if morphine CI due to renal failure.
How do you calculate the dose of opioid to give for breakthrough analgesia in palliative care?
One sixth of the total daily dose.
What are some anticipatory drugs that are prescribed for breathlessness EoL?
- therapeutic oxygen
- morphine
- midazolam
