Advance care planning: a personal view and stories from the frontline

2018 ◽  
Author(s):  
Tony Bonser
Keyword(s):  
Advance Care Planning ◽  
Good Practice ◽  
Societal Implications ◽  
National Council ◽  
Care Planning ◽  
Personal View ◽  
Positive Effects ◽  
Health And Social Care ◽  
Advance Care ◽  
High Level

This chapter includes a personal view of advance care planning (ACP) from Tony Bonser, whose son, Neil died aged 35 and who now works for the National Council for Palliative Care, with examples from others. It describes the importance and impact of ACP on people nearing the end of life and their families, and recommends that ACP should be mainstreamed across health and social care as part of good practice, and become part of the public debate through movements like Dying Matters. It affirms that ACP: enables a dialogue to be started; must be centred on patients and enable the implementation of patient wishes; will centre on giving advice rather than prescribing outcomes; has positive effects; needs high-level communication skills; helps restore control; and has societal implications.

Advance care planning in an Asian country

2018 ◽  
Author(s):  
Irwin Clement ◽  
Alphonsus Wai ◽  
Hoong Chung
Keyword(s):  
Nursing Homes ◽  
End Of Life ◽  
Acute Care ◽  
Advance Care Planning ◽  
Social Care ◽  
Asian Country ◽  
Care Planning ◽  
Care Continuum ◽  
Health And Social Care ◽  
Advance Care

Advance care planning (ACP) was introduced to Singapore in the late 2000s in the form of local projects that encouraged conversations on end-of-life concerns, beginning first with residents in several nursing homes. High patient receptivity to the concept of planning ahead for care and death was encouraging, which prompted Ministry of Health to approve an S$18.1m effort to develop and promote ACP nationally in 2011. Since then, the practice of ACP has gradually spread throughout the country’s public acute care hospitals, most community hospitals, and all nursing homes, as well as a handful of eldercare providers, with close to 5,000 plans lodged electronically, 2,000 ACP conversation facilitators trained across the health and social care continuum and more than 1,000 community ACP advocates activated.

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.

scholarly journals A training needs analysis of admiral nurses to facilitate advance care planning in dementia

2019 ◽  
Vol 12 ◽  
pp. 117822421985018 ◽  
Author(s):  
Karen Harrison Dening ◽  
Caroline Scates ◽  
George McGill ◽  
Kay De-Vries
Keyword(s):  
Advance Care Planning ◽  
Qualitative Data ◽  
Training Needs ◽  
Needs Analysis ◽  
Care Planning ◽  
Planning Support ◽  
Health And Social Care ◽  
Future Care ◽  
Advance Care ◽  
Subjective Level

Education of health and social care professionals is essential in preparation to confidently and effectively support families affected by dementia to undertake advance care planning. This article describes a training needs analysis of Admiral Nurses, dementia specialists, in facilitating advance care planning for future care. Methods: A questionnaire survey was completed by Admiral Nurses attending end-of-life care masterclasses in 2017 and 2018. Both quantitative (years registered as a nurse, years as an Admiral Nurse and subjective level of confidence in completing advance care plannings) and qualitative data (interventions perceived to increase confidence) were collected. Findings: There were 75 completed responses (two incomplete returns). There was no correlation between levels of confidence and years registered as a nurse. However, there was a small positive correlation between confidence and number of years as an Admiral Nurse ( r = 0.23; p < 0.05). Themes identified qualitatively to enhance practice were advanced communication skills, supervised practice, resources to frame conversations and a guide and template for advance care planning. Conclusion: Although Admiral Nurses are specialists in dementia, several educational initiatives could be employed to better enable them to support advance care planning for families affected by dementia. This training needs analysis is contributed towards developing an educational intervention for Admiral Nurses to improve advance care planning support.

scholarly journals Association Between Advance Care Planning for Older Adults and Family Caregivers’ Sense of Security

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 356-357
Author(s):  
Masumi Shinohara ◽  
Mariko Sakka ◽  
Asa Inagaki ◽  
Taisuke Yasaka ◽  
Chie Fukui ◽  
...  
Keyword(s):  
Older Adults ◽  
Family Caregivers ◽  
Advance Care Planning ◽  
Adult Children ◽  
Interactive Effect ◽  
Adult Child ◽  
Care Planning ◽  
Positive Effects ◽  
Sense Of Security ◽  
Advance Care

Abstract Family caregivers’ (FCs’) sense of security benefits older adults who receive homecare. Advance care planning (ACP) is reported to have positive effects on FC’s experience, but it might differ depending on FCs’ kin relationships with the older adults. We examined whether ACP for older adults in homecare settings is associated with FCs’ sense of security. Further, we assessed whether such an association depends on their status as spouses or as adult children. We conducted a secondary analysis of data from a prospective cohort study in Japan. The participants were older adults who used home-visit nursing services, their FCs, and the nurses who cared for them. The FCs were asked to answer a sense of security questionnaire, and nurses were asked whether ACP was conducted. Multivariate logistic regression analyses were performed to examine the association between ACP implementation and positive changes in the sense of security scores after three months. Data from 169 cases were analyzed. Of the FCs, 28.1% were men and 55.6% were spouses. ACP was performed in 53.8% of the cases. The results of the multivariate analyses showed an interactive effect between ACP implementation and FC kin relationships. For spouses, ACP was significantly associated with a positive change in their sense of security. For adult children, such an association was not found. ACP might have a positive effect on caregiving spouses’ sense of security. Adult child caregivers, who often have multiple responsibilities and have difficulties facing their parents’ physical decline, may need support, in addition to ACP.

scholarly journals Older Couples’ Advance Care Planning Engagement Patterns and Associations with Individual and Spousal Factors

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 778-778
Author(s):  
Hyo Jung Lee ◽  
Bon Kim
Keyword(s):  
Advance Care Planning ◽  
Psychological Health ◽  
Latent Class ◽  
Care Planning ◽  
Multinomial Regression ◽  
Older Couples ◽  
Advance Care ◽  
Using Data ◽  
High Level ◽  
Retirement Study

Abstract This study examines older couples’ dyadic patterns of informal and formal advance care planning (ACP) and determines the associations of these patterns with their own and spousal characteristics. Using data from the 2014 and 2016 Health and Retirement Study, we performed a) latent class analysis to identify distinctive ACP engagement patterns and b) multinomial regression models to describe related characteristics of older couples (N = 1,545 couples). We identified four dyadic patterns of ACP engagement: a) high ACP engaging couple (45%); b) high engaging husband – low engaging wife (13%); c) high engaging wife – low engaging husband (11%); and d) low engaging couple (31%). Engagement in informal and formal ACP was associated with both individual and spousal factors: Older couples with advanced age or higher levels of education and wealth were more likely to engage in both informal and formal ACP, whereas only wife’s high level of constrain or husband’s greater number of depressive symptoms was associated with discordant ACP engagements. Couple-based approach to promote ACP merits older couples with limited resources or poorer psychological health in both or either spouse.

Delivering an advance care planning facilitated model

2019 ◽  
Vol 25 (6) ◽  
pp. 264-273 ◽  
Author(s):  
Christine Fretwell ◽  
Pat Worlock ◽  
Aoife Gleeson
Keyword(s):  
Advance Care Planning ◽  
Social Care ◽  
Public Awareness ◽  
Health Board ◽  
Successful Implementation ◽  
Care Planning ◽  
Collaborative Approach ◽  
Strategic Objectives ◽  
Health And Social Care ◽  
Advance Care

Background: Advance care planning is increasingly recognised as an integral part of achieving excellence at the end of life (EoL), but barriers still prevent individuals from having the opportunity to discuss their wishes and preferences for the future. Aim: To describe the development and initial evaluations of an innovative facilitated ACP model, the ACP Triple E, which empowers individuals through education to engage in ACP conversations. Methods: This model uses a collaborative approach involving all sectors of a large university health board to equip all health and social care professionals with the knowledge, skills and confidence to engage in ACP discussion and also raise public awareness of the benefits of ACP. Conclusion: This model includes recognised elements that support successful implementation of ACP. Initial evaluations of the model are extremely positive. Further analysis of the data is now needed to evaluate the model's flexibility and its ability to change practice and achieve strategic objectives.

scholarly journals GPs’ perceptions of advance care planning with frail and older people: a qualitative study

2017 ◽  
Vol 68 (666) ◽  
pp. e44-e53 ◽  
Author(s):  
Tim Sharp ◽  
Alexandra Malyon ◽  
Stephen Barclay
Keyword(s):  
Older People ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Social Care ◽  
Care Planning ◽  
Life Care ◽  
Care Providers ◽  
Health And Social Care ◽  
Advance Care

BackgroundFrail and older people are estimated to account for 40% of deaths. Despite conversations about end-of-life care being an important component of the national End of Life Care Strategy, there is a marked disparity between the majority who would like to discuss advance care plans, and the minority who currently have this opportunity.AimTo investigate the attitudes of GPs to advance care planning (ACP) discussions with frail and older individuals.Design and settingFocus group study with GPs in Cambridgeshire between September 2015 and January 2016.MethodFive focus groups with 21 GPs were purposively sampled to maximise diversity. Framework analysis was used to analyse transcripts and develop themes.ResultsAlthough some GPs were concerned it might cause distress, the majority felt that raising ACP was important, especially as preparation for future emergencies. Knowing the individuals, introducing the idea as part of ongoing discussions, and public awareness campaigns were all facilitators identified. Several considered that service limitations made it difficult to fulfil patients’ wishes and risked raising unrealistic patient expectations. Other barriers identified included uncertainty over prognosis and difficulties ensuring that individuals’ wishes were respected.ConclusionMost GPs viewed ACP as important. However, their enthusiasm was tempered by experience. This study highlights the difficulties for GPs of encouraging dialogue and respecting individuals’ wishes within the constraints of the existing health and social care system. National publicity campaigns and encouraging patients to prioritise healthcare outcomes could help GPs raise care preferences without causing a detrimental impact on patients or raising unrealistic expectations. Once patients agree their care preferences, they need to be documented, accessible, and reviewed by all relevant health and social care providers to ensure that their wishes are respected, and plans amended as their circumstances change.

Development and implementation of an advance care planning program in Catalonia, Spain

2018 ◽  
Vol 17 (04) ◽  
pp. 415-424 ◽  
Author(s):  
Cristina Lasmarías ◽  
Amor Aradilla-Herrero ◽  
Sebastià Santaeugènia ◽  
Carles Blay ◽  
Sara Delgado ◽  
...  
Keyword(s):  
Social Services ◽  
Advance Care Planning ◽  
Chronic Conditions ◽  
Online Training ◽  
Care Planning ◽  
Chronic Patients ◽  
Training Course ◽  
Health And Social Care ◽  
Wide Range ◽  
Advance Care

AbstractObjectiveImplementation of an advance care planning (ACP) program for people with advanced chronic conditions is a complex process. The aims of this paper are to describe (1) the development of the ACP program in Catalonia, Spain, for patients with advanced chronic conditions and complex needs and (2) the preliminary results of the implementation of this program in health and social services.MethodThe ACP program was developed and implemented in a four-stage process as follows: (1) design and organization of the project; (2) selection of the professionals to carry out the project; (3) creation of four working groups to develop the conceptual model, guidelines, training program, and perform a qualitative evaluation; and (4) project implementation.ResultThe following deliverables were completed: (1) conceptual framework document; (2) practical guidelines for the application of the ACP; (3) online training course (3,763 healthcare professionals completed the online course, with an overall satisfaction rating of 8.4 on a 10-point scale); and (4) additional training activities (conferences, short courses, and seminars) in between 2015 and 2017.Significance of resultsThis project was led by the Catalan Ministry of Health. The strengths of the project development include the contribution of a wide range of professionals from the entire region, approval by the Catalan Bioethics Committee and the Social Services Ethics Committee, and the ongoing validation by members of the community. A standardized online training course was offered to all primary care professionals and included as a quality indicator for continuing education for those professionals in the period 2016–2020. The main outcome of this project is the establishment of a pragmatic ACP throughout the region and training of the health and social care professionals involved in the care of advanced chronic patients.

scholarly journals Planning for tomorrow whilst living for today: the views of people with dementia and their families on advance care planning

2013 ◽  
Vol 25 (12) ◽  
pp. 2011-2021 ◽  
Author(s):  
Claire Dickinson ◽  
Claire Bamford ◽  
Catherine Exley ◽  
Charlotte Emmett ◽  
Julian Hughes ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Social Care ◽  
Evidence Base ◽  
Care Planning ◽  
Structured Interviews ◽  
Care Plans ◽  
People With Dementia ◽  
Health And Social Care ◽  
Advance Care ◽  
The Right

ABSTRACTBackground:Advance care planning (ACP) is increasingly prominent in many countries; however, the evidence base for its acceptability and effectiveness is limited especially in conditions where cognition is impaired, as in dementia.Method:This qualitative study used semi-structured interviews with people with mild to moderate dementia (n = 17) and family carers (n = 29) to investigate their views about planning for their future generally and ACP specifically.Results:People with dementia and their families make a number of plans for the future. Most people undertook practical, personal, financial, and legal planning. However participants did not make formal advance care plans with the exception of appointing someone to manage their financial affairs. Five barriers to undertaking ACP were identified: lack of knowledge and awareness, difficulty in finding the right time, a preference for informal plans over written documentation, constraints on choice around future care, and lack of support to make choices about future healthcare.Conclusions:Health and social care professionals can build on people's preferences for informal planning by exploring the assumptions underlying them, providing information about the possible illness trajectory and discussing the options of care available. Health and social care professionals also have a role to play in highlighting the aspects of ACP which seem to be most relevant to the wishes and aspirations of people with dementia.

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