End of life care

Question 1

What is the hierarchy for needs-based palliative care model?

Answer 1

Question 2

What are the principles of advanced care planning?

Answer 2

• It is defined as the opportunity for people to think, discuss and plan for the medical treatment they would prefer if they become too ill in the future to express their wishes
• It involves completing a legally binding document called the advance health directive (AHD) or living will
• There is evidence that it leads to more satisfied bereaved carers who experience less anxiety and depression
• PEPSI COLA framework can be used for planning
• Co-ordinated care reduces hospital admission by 30% and improves functioning persistently and improves quality of life in the last month

Question 3

What are the solutions to improved end of life care planning?

Answer 3

• Advanced care planning
• Palliative specilaist team support for GPs
• Accessible to patients
• Caring for the carer
• Training young GPs

Question 4

What are some useful resources for end of life care?

Answer 4

eTG Palliative care

EVIq cancer treatments online (EVIQ.org.au)

GP pain help

ACCRRM I tunes

Flinders University GP hub

Advance care planning Australia

UQ needs assessment tool-for carers

Question 5

What are the medico-legal issues involved with ACD?

Answer 5

• If an ACD is made by a capable adult and is clear and unambiguous, and extends to the situation at hands, it must be respected
• It would be battery to administer medical treatment to a person when prohibited by ACD
• There is a presumption that an adult is capable of deciding whether to consent to or refuse medical treatment; however the presumption is rebuttable
• If there is doubt about the validity of an ACD, the GP should apply to court; emergency principle can be used to treat the patient until court gives permission for further management
• ACD as long as it is made voluntarily in the absence of vitiating factor such as misinterpretation does not need to be supported by any scientific information

Question 6

What are the code of ethics for ACDs?

Answer 6

• Respct for persons autonomy
• Competent adults are autonomous individuals
• Autonomy can be exercised in different ways depending on culture,background, religious and spiritual beliefs
• Adults are presumed competent
• Directions in ACDs may reflect broad concept of health
• It can relate to any time in future
• The substitute decision maker has the same authority as the person when competent
• If valid, ACD can be relied upon
• A refusal of a health related intervention in an ACD must be followed
• A valid ACD that expresses preferences or refusals relevant and specific to the situation at hand must be followed

Question 7

What are the problems and challenges with ACDs?

Answer 7

• The person may lack the information required to make an informed choice
• An individuals treatment choices can change over time such that an ACD may not accurately reflect the persons choices at a later date
• The persons wishes may not be able to be accurately ascertained fro an ACD
• An ACD may not be located when needed
• Each state and territory has a different legislative framework for ACDs

Question 8

What are the state and territory restrictions on ACDs?