wIPADS

Advance Care Planning

Prepare the ground

Before starting any discussion about Advance Care Planning, ensure that the patient and/or family have been given the opportunity to understand the nature and prognosis of their illness through adequate discussion.

Where appropriate, prompt the patient to consider likely/expected complications e.g. the need for PEG feeding in MND.

If the patient does not wish to discuss their condition or the prognosis, their wishes should be respected. It may still be possible to ascertain some of their wishes or preferences, so this should not prevent you from continuing to explore their views.

The Communication Skills guide to starting ACP may be helpful.

Does the patient have Mental Capacity?

For patients who do not have mental capacity to make such decisions, it may still be possible to pursue some form of advance planning with the family; consider the RBID (Record of Best Interests Decisions).