Advance Care Planning
Advance Care Planning (ACP) is a voluntary process that gives people with capacity the opportunity to discuss and document their wishes and preferences for their future care and support. Advance Care Planning is a way to think ahead, to describe what matters to you and to ensure that other people know your wishes for the future. It’s about helping you to live well, right to the end of your life.
Introduction
Thinking ahead, discussing with others and writing things down means that your wishes are known and respected. So if you become unwell, or can no longer speak for yourself, you are more likely to receive the kind of care you want in the place you choose.
If someone doesn’t have the mental capacity to carry out advance care planning then discussion with their family, Lasting Power of Attorney (LPA), GP, nurse or social worker can help determine what would be in your ‘Best Interests’. Best Interest Meetings are formal gatherings designed to support decision-making on behalf of individuals who lack the capacity to make decisions themselves.
These meetings are governed by the principles outlined in the Mental Capacity Act, which emphasise the importance of acting in the individual’s best interests, considering their past and present wishes, feelings, beliefs, and values.
A best interest meeting may also include an independent Mental Capacity Advocate (IMCA) where there is no one independent of services, such as a family member or friend, who is able to represent the person.
The Advance Care Planning Process can be covered in 5 simple steps.
Step 1 - Think
Think about the future:
- What matters to you?
- What would you want to happen if you become unwell?
- What would you not want to happen to you?
- Who would speak for you if you could no longer speak for yourself?
Step 2 - Talk
Talk with family and friends. Make sure they are aware of your choices. And ask someone you know to be your Lasting Power of Attorney (LPA) for health and welfare to speak on your behalf if in the future you are unable to speak for yourself. You may also want to consider LPA for your property and financial affairs. https://www.gov.uk/power-of-attorney
Step 3 - Record
Write down your thoughts or ask someone to help you record your wishes as your own Advance Statement Care Plan. There are different ways of doing this. You could use your local GP’s form, the GSF Thinking Ahead tool or another Advance Care Planning document. Or you could complete it online as part of your digital legacy planning. Whatever method you choose, make sure those that care for you know about it and can find it when needed including your Lasting Power of Attorney for health and welfare.
Step 4 – Discuss
Discuss your plan with those that look after you. This could be your doctor, nurse or your care provider. Tell them, What matters to you, where you prefer to be cared for and the kind of things you would like to happen to you. This is known as an Advance Statement.
You may want to discuss what you don’t want to happen, known as an Advance Decision to Refuse Treatment.
You may also want to discuss Who will speak for you, if you lacked the capacity and were unable to speak for yourself, who would you want to speak for you? Lasting Power of Attorney for health and welfare.
The Clinician may want to discuss treatment preferences on what to do in an emergency situation- if your heart should suddenly stop – cardiopulmonary discussions . The Clinician may have documented treatment preferences in an emergency health care plan, Treatment Escalation plan, ReSPECT or Deciding rights document.
It is important that all these documents are kept safely and easy to locate in an emergency situation
Step 5 - Share
Share this information with family and or friends involved in your care and let them know where the documentation is kept. Your healthcare team with your consent will make sure it is shared with others involved in your care.
Review
As time passes your situation can change so it is important to review your Advance Care Plan regularly. If you need to update it it’s best to discuss it with your doctor, nurse or your care team and let your family /LPA know.
You can do Advance Care Planning at any time but it is especially important towards the end of life. It will help you get the care you really want and live the life you want to lead
Just remember the GSF 5 simple steps – think, talk, record, discuss, share.
Advance Care Planning Resources
