CHESHIRE MERSEYSIDE PALLIATIVE AND END OF LIFE CLINICAL

CHESHIRE & MERSEYSIDE PALLIATIVE AND END OF LIFE CLINICAL NETWORK ADVANCE CARE PLANNING FRAMEWORK PROMOTING CONVERSATIONS AND PLANNING YOUR FUTURE CARE

What is ACP? • Process for planning for future health and personal care • Beliefs and preferences used to guide clinical decision making in future when person unable to make / communicate them • Verbal or written • Strengthened if written

Who is ACP for? • Frail elderly • People of any age with chronic progressive and life-limiting conditions • People approaching end of life • People with multiple co-morbidities and /or at risk of stroke or heart failure • People with early cognitive impairment

Why do ACP? 1. Deliver patient centred care • Enabled to make decisions regarding their own care • Reduces anxiety / Improve Qo. L / improve chronic disease management • People engaged with decisions more satisfied with their care • Reduce unwanted / unnecessary treatment

Why do ACP? 2. Caring for an ageing population • Over 70 years more likely admitted to hospital with multiple co-morbidities including dementia • Complex needs with decision making needed from wide group of specialists • Many older people have limited decision making capacity before they die • Elderly often do not want life prolonging treatments if no realistic expectation of recovery

What do people want at End Of Life? • • • Symptoms managed Avoid prolongation of dying Achieving a sense of control Relieving burdens placed on families Strengthening relationships Singer et al 1998; Steinhauser et al 2000

In the 21 st century, people are living longer, ageing further and dying slower, with more degenerative disease, than ever before. The medicalization of death has resulted in us dying away from home, in relative isolation, often in a hospital where the first priority is to prevent death. We face an increasingly degenerative end to life with less and less control over our dying process GUY BROWN. AUTHOR OF ‘THE LIVING END’ COMPASSION IN DYING TRUSTEE

You Gov / Compassion in Dying Survey 2013 82% people have strong views about EOL care 4%have ADRT 9% GPs not heard of ADRT 48% wrongly believe legal right to decide to make treatment decisions 22% don’t know 4% refused to sign ADRT validity/payment

Cheshire & Merseyside Network

Network ACP project • 12 months to develop ACP framework • Clinical lead Palliative Medicine Consultant • Scoping / literature review • Project management group – Multi-disciplinary - All areas - 3 Patient representatives • Clear governance structure

Network ACP Project Objectives • Agree principles and working definitions • Make recommendations on utility of identification tools • Make recommendations to promote discussions of ACP among wider public • Make recommendations regarding development of systems for transfer of information • Recommendations of educational models • Recommendations on assessment of ACP process

Future care planning Definition of the ACP process

Statement ofof wishes, beliefs && prefences preferences INF Named person to speak on behalf ORM AL Future Care planning Do Not Attempt Resuscitation Definition of the ACP process

Appoint someone to make decisions Statement of wishes, beliefs & preferences INF Named person to speak on behalf AL M OR Advance ORM AL F Future care planning Do Not Attempt Resuscitation Clinical Management Plan Definition of the ACP process Decision to Refuse Treatment

Appoint someone to make decisions Statement of wishes, beliefs & preferences INF Named person to speak on behalf L ORM A M R FO AL Future Care planning Advance Decision to Refuse Treatment CLINICAL Do Not Attempt Resuscitation Clinical Management Plan Definition of the ACP process

Appoint someone to make decisions Statement of wishes, beliefs & preferences INF Named person to speak on behalf L ORM A M R FO AL Future Care planning Advance Decision to Refuse Treatment CLINICAL Do Not Attempt Resuscitation Clinical Management Plan Electronic Palliative Care Co-ordination Systems (EPa. CCS)

ADVANCE CARE PLANNING CLINICAL Do Not Attempt Resuscitation Clinical Management Plan

ADVANCE CARE PLANNING ANTICIPATORY CLINICAL PLANNING

ADVANCE CARE PLANNING BEST INTEREST DECISION ANTICIPATORY CLINICAL PLANNING

Achieved • Agree principles and working definitions • Make recommendations on utility of identification tools • Make recommendations to promote discussions of ACP among wider public • Make recommendations regarding development of systems for transfer of information • Recommendations of educational models • Recommendations on assessment of ACP process

Way forward • Framework and all forms available at: www. cmscnsenate. nhs. uk • Disseminate network wide • Local Implementation plans