Overview and introduction to advance care planning

2018 ◽  
Author(s):  
Keri Thomas
Keyword(s):  
Advance Care Planning ◽  
Public Awareness ◽  
Evidence Base ◽  
Care Planning ◽  
Introductory Overview ◽  
Advance Care ◽  
Advance Statements ◽  
Mental Capacity Act ◽  
The Uk ◽  
Evolving Models

This chapter provides an introduction to advance care planning (ACP) and an introductory overview of the book. It affirms the importance of ACP, the strong evidence base and experience in practice. It cites the current and evolving models of ACP in the UK, linked with the Mental Capacity Act, and the use of advance statements (AS), refusals of treatment (ADRT) and nominated spokesperson (LPOA). There is encouragement that most can initiate such discussions and suggested ways to do this. It describes the evolving ACP model balancing both medical (transactional) and personal (transformational) aspects of it, with a description of the different conversations and suggested five steps in ACP to raise public awareness. There is a reflection of the deeper significance of ACP including hope and expectations, concluding with a call for ACP to become a mainstream part of care for all people nearing the end of life.

The implications of the Mental Capacity Act (MCA) 2005 for advance care planning and decision making

2018 ◽  
Author(s):  
Simon Chapman ◽  
Ben Lobo
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Advance Care Planning ◽  
Care Planning ◽  
Best Interest ◽  
Policy And Practice ◽  
Advance Care ◽  
Current Context ◽  
Mental Capacity Act ◽  
End Of Life Decision

This chapter provides an overview of the MCA’s impact on end-of-life care. It situates the MCA in the current context of policy and practice. It describes how the MCA can be used to improve care, enable people to express and protect choices, and empower and enable the professional and/or the proxy decision maker. It also presents an introduction and explanation of the role of the IMCA and how it might apply to advance care planning (ACP) and end of life decision making, and an explanation of the legal and ethical process involved in reaching best interest decisions, especially for potentially vulnerable people in care homes and other settings.

Advance care planning: the future

2020 ◽  
pp. bmjspcare-2020-002304
Author(s):  
Judith Rietjens ◽  
Ida Korfage ◽  
Mark Taubert
Keyword(s):  
Advance Care Planning ◽  
Public Awareness ◽  
Care Planning ◽  
Decisional Capacity ◽  
Best Interest ◽  
Awareness Campaigns ◽  
People With Dementia ◽  
Future Care ◽  
Advance Care ◽  
Improve Patient

ObjectivesThere is increased global focus on advance care planning (ACP) with attention from policymakers, more education programmes, laws and public awareness campaigns.MethodsWe provide a summary of the evidence about what ACP is, and how it should be conducted. We also address its barriers and facilitators and discuss current and future models of ACP, including a wider look at how to best integrate those who have diminished decisional capacity.ResultsDifferent models are analysed, including new work in Wales (future care planning which includes best interest decision-making for those without decisional capacity), Asia and in people with dementia.ConclusionsACP practices are evolving. While ACP is a joint responsibility of patients, relatives and healthcare professionals, more clarity on how to apply best ACP practices to include people with diminished capacity will further improve patient-centred care.

scholarly journals ‘It’s almost superstition: If I don’t think about it, it won’t happen’. Public knowledge and attitudes towards advance care planning: A sequential mixed methods study

2021 ◽  
pp. 026921632110158
Author(s):  
Sonja McIlfatrick ◽  
Paul Slater ◽  
Olufikayo Bamidele ◽  
Deborah Muldrew ◽  
Esther Beck ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Group ◽  
Advance Care Planning ◽  
Public Awareness ◽  
Community Action ◽  
Care Plan ◽  
Care Planning ◽  
Knowledge And Attitudes ◽  
Sequential Mixed Methods ◽  
Advance Care

Background: Internationally, participation in advance care planning is low. Whilst a community action approach is advocated, what the public know and understand about advance care planning is unknown. Aim: To assess public awareness, knowledge and attitudes towards advance care planning and identify strategies to raise awareness within a public health framework. Design: Sequential mixed methods comprising a cross-sectional survey and focus group/interviews. Setting/participants: A random representative sample of adults from one region of the United Kingdom ( n = 1201; response rate 56%) completed a face-to-face survey. Twenty-five participants consented to an additional focus group/interview held in a secure accessible location or via telephone. Results: Most participants (78.7%) acknowledged the benefits of advance care planning conversations, however, two thirds did not want to think about advance care planning or find out more at present. Respondents were reluctant to broach advance care planning as it was linked to end of life care and funeral plans, and they did not wish to cause distress to their loved one. Respondents trusted their family to respect their wishes and they considered having an advance care plan in place would be of assistance in the future. Top-down leadership, normalisation, and increased education were identified as potential approaches to overcome barriers. Conclusions: Advance care planning was recognised as important despite limited awareness, lack of knowledge and misperceptions. Whilst a community action approach to enhance understanding and engagement was supported, a ‘one size fits all’ approach will not work; rather bespoke targeting is required with educational and media messaging aligned.

scholarly journals Advance care planning evaluation: a scoping review of best research practice

2021 ◽  
pp. bmjspcare-2021-003193
Author(s):  
Sophie Gloeckler ◽  
Tanja Krones ◽  
Nikola Biller-Andorno
Keyword(s):  
Advance Care Planning ◽  
Scoping Review ◽  
Retrospective Chart Review ◽  
Evidence Base ◽  
Future Research ◽  
Care Planning ◽  
Completion Rates ◽  
Future Care ◽  
Actual Care ◽  
Advance Care

Various indicators have been used to evaluate advance care planning, including completion rates, type of care received, and satisfaction. Recent consensus suggests, though, that receiving care consistent with one’s goals is the primary outcome of advance care planning and assessment should capture this metric. Goal concordant care is challenging to measure, and there is little clarity about how best to do so. The aim of this scoping review is to explore what methods have been used to measure goal concordant care in the evaluation of advance care planning. PubMed, Embase, PsycINFO, CINAHL and Cochrane were searched in September 2020 to identify studies that aimed to track whether advance care planning affected the likelihood of patients receiving care that matched their preferred care. 135 original studies were included for review. Studies used retrospective chart review (36%, n=49), questionnaire (36%, n=48) and interview (31%, n=42), focusing on both patients and proxies. Studies considered both actual care received (55%, n=74) and hypothetical scenarios anticipating possible future care (49%, n=66); some studies did both. While the reviewed studies demonstrate the possibility of working towards a solid methodology, there were significant weaknesses. Notably, studies often lacked enough reporting clarity to be reproducible and, relatedly, key concepts, such as end-of-life or preferred care, were left undefined. The recommendations that follow from these findings inform future research approaches, supporting the development of a strong evidence base to guide advance care planning implementation in practice.

Advance care planning in the UK: update on policy and practice

2018 ◽  
Author(s):  
Claire Henry ◽  
Keri Thomas
Keyword(s):  
Family Involvement ◽  
Advance Care Planning ◽  
Information Transfer ◽  
Care Staff ◽  
Care Planning ◽  
Power Of Attorney ◽  
Policy And Practice ◽  
Health And Social Care ◽  
Advance Care ◽  
The Uk

This chapter provides an introduction to and national context for the importance of advance care planning (ACP) in the Department of Health End of Life Care Strategy in England. It also presents background publications which have highlighted the need for ACP, issues surrounding ACP, resources to support the process of ACP, the practicalities of implementation, and further developments. ACP is delivered as a process of discussion between an individual and their care provider, irrespective of discipline, with or without their carer/family involvement. Outputs may include a statement of wishes and preferences, decisions to refuse treatment, and/or Lasting Power of Attorney. Meanwhile, guidance from Health and Social Care Staff has been published. Further work is underway in areas of education, communication, and information transfer.

Advance care planning and treatment escalation plans

2020 ◽  
Vol 13 (2) ◽  
pp. 109-116 ◽  
Author(s):  
Ellie Courtney
Keyword(s):  
Advance Care Planning ◽  
Legal Framework ◽  
Care Planning ◽  
Do Not Resuscitate ◽  
Advance Care ◽  
The Uk ◽  
Treatment Escalation ◽  
Multiple Chronic Diseases ◽  
Huge Challenge

Medicine has advanced rapidly over the past 100 years. People are living longer, sometimes with multiple chronic diseases. When they develop life-limiting conditions, some already old and frail, achieving balance between intervening too much and too little can be a huge challenge. In many areas of the UK treatment escalation plans (TEPs) are replacing do not resuscitate orders. The aims of this article are to explore the use of TEPs and the role of advance care planning, covering the legal framework and providing some practical guidance about how to approach this important conversation.

How to Measure Goal Concordant Care in Order to Evaluate Advance Care Planning with Integrity: A Literature Review

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 80-80
Author(s):  
Sophie Gloeeckler ◽  
◽  
Manuel Trachsel ◽  
Keyword(s):  
Literature Review ◽  
Medical Record ◽  
Advance Care Planning ◽  
Best Practice ◽  
Evidence Base ◽  
Medical Record Review ◽  
Care Planning ◽  
Advance Care ◽  
The Many ◽  
Record Review

"Advance care planning is an effort to consider and communicate one’s values, goals, and preferences as they relate to future healthcare decisions to guide clinicians and loved ones when one is incapable of consenting, refusing, or requesting care. While generally accepted as valuable, advance care planning has proven challenging to evaluate. Goal concordant care is increasingly recognized as the target outcome, but there is no agreed-on methodology for assessment and some question if it can be meaningfully captured. It is ethically necessary to have a strong evidence base to guide practice. The current study is a literature review designed to support best practice for measuring goal concordant care. A database search of Pubmed, Embase, PsycINFO, CINAHL, and Cochrane was conducted in September 2020; articles were included that measured whether advance care planning, defined broadly to consider advance directives, use of proxies, POLSTs, etc., led to goal concordant care. 132 included articles were reviewed according to aim, methodology, and integrity. Common approaches included medical record review 51% (n = 36); questionnaire (36%, n = 48), notably the Decision Conflict Scale (15% of questionnaires, n = 7); and interview (31%, n = 42), often with loved ones after death (40% of interviews, n = 17). Studies, especially those employing medical record review, did not always present enough detail to be reproducible, a concerning limitation. Despite the many existing studies aiming to track whether advance care planning leads to goal concordant care, significant work remains to establish sound methodology to do so meaningfully. "

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