Advance Care Planning
Encourage the patient to share their wishes with a family member.
This is very important for two reasons: 1) to facilitate open discussion within the family about the patient's condition and prognosis; 2) to avoid surprises or disagreements if or when the time comes when the patient is unable to make decisions about their own care.
With the patient's consent, ensure that the advance care plan is available to other healthcare professionals when it is needed.
If appropriate, the original Advance Care Plan document(s) should be kept by the patient in their own home. If the patient has district nursing notes in the house, this may be the best place.
Consider any of the following:
1) Send a copy of the ACP document, or inform others that one exists (e.g. using the Advance Care Planning communication form):
- Primary care
- Hospital / Specialist Palliative Care teams
- Out-of-hours service
- WAST ambulance service
2) Update your computer records:
- GP computer system
- CaNISC (oncology & Specialist Palliative Care teams)
3) In some circumstances (especially if the patient lives alone), consider other ways to alert attending professionals e.g. MedicAlert bracelet, or a Message in a Bottle.
ADVANCE CARE PLANNING COMMUNICATION FORM
- Advance care planning communication form
Pro forma. Authors: Palliative Care ACP Working Group