AMA VICDOC Spring 2023 - Magazine - Page 41
S
ometimes it’s hard for patients
and families to consider the
benefits and relevance of
advance care planning (ACP)
but widespread media attention during
COVID-19 has helped the general public
to understand the limitations of medical
care and the reality that sudden events
can happen to anyone. Confronting
images are hard to ignore. People can
suddenly imagine a scenario where they
might be unable to make their own
medical decisions or consider medical
interventions they would prefer to avoid.
We health professionals know ACP
can reduce anxiety, depression and
stress. ACP has benefits for the patients,
who can avoid unwanted interventions,
plus the health system can also benefit
in terms of allocation of resources. But
given that so many people will be unable
to make their own end-of-life decisions,
it’s troubling that less than 15 per cent
of Australians have documented their
preferences in an advance care
directive (ACD).
ACP AND CANCER
Advance Care Planning Australia
(ACPA) recently published a study to
better understand the experiences of
people with cancer and their support
people, in relation to advance care
planning. People with cancer often face
complex and difficult decisions related
to treatment. Up to half of patients with
advanced cancer experience delirium
on admission to hospital, while 90 per
cent will experience delirium in the days
before death.
The findings highlight important
questions around when the sensitive
topics of ACP and end-of-life care should
be raised in cancer care. Around 40 per
cent of respondents said they wanted to
discuss ACP and end-of-life care when
their disease was no longer curable, and
a third said they’d prefer to raise the
matter when they felt the time was right.
Only 4 per cent of study participants
reported that they didn’t want to discuss
ACP and end-of-life care at all.
The findings of the study suggest that
people with cancer and support people
should have the opportunity to engage
with ACP at regular intervals throughout
their ‘cancer journey’. Yet we know that
doctors frequently report a lack of time,
knowledge and skills in ACP as a
key barrier.
THE THREE SENTENCE ACP
CONVERSATION STARTER
When I did ACP training over a decade
ago, it was a two-day extravaganza
accompanied by a huge binder folder
bursting with papers and forms. It
seemed complex and intimidating.
In real life though, I have found a
simpler approach to be easier for both
me and my patients and their families
that starts with three sentences:
“If you were to become so unwell
that you could not talk to the doctors
about what treatments you wanted,
and didn’t want…
“Who would
talk for you?
And would
they know
what to say?”
I might then be able to identify straight
off that they have a medical treatment
decision-maker in mind, or have already
appointed one.
I can also send the patient home
with a copy of an advance care directive
to consider and bring back next time,
or refer them to the website which has
forms and information for each state.
I also refer patients to the free ACPA
advisory service (see contact details to
the right).
With luck, at the next appointment
we can document the medical treatment
decision-maker and the patient and
family might have discussed preferences
or even started the advance care
directive. Documenting conversations
and communicating with other health
providers is really important. If we
physically sign forms, I make sure to
print off five copies and hand four to
the patient to distribute.
I find this approach to be
relatively quick and stress-free. Don’t
underestimate the importance of printing
copies and communicating with the
patient’s other care providers, such as
GPs and community palliative care.
PULSE
Doctors frequently
report a lack of time,
knowledge and
skills in ACP.
Find resources,
forms and online
learning at advance
careplanning.org.au.
For free advice call
1300 208 582,
Mon-Fri, 9am-5pm.
National Advance
Care Planning
Week is 22-26
March 2021.
Happy advance care planning!
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