The GPs who attended the education session at Ashgrove had an interesting presentation about bone scans then we went off on a completely different tangent on Advanced Care Planning with lots of discussion.
Advanced Care Planning is a conversation with your patient about their wishes when they become unwell or seriously injured. The conversation will differ depending on the circumstances and will be different for someone terminally ill to someone who is getting older but still well. The family needs to be involved so they are also aware of the person’s wishes. This often prevents angst when the time comes to makes decisions about the patients’ care particularly if the patient has become incapable of making a decision for themselves. There needs to be an understanding of the consequences of some of the decisions to enable to person to decide on what they would like to happen. If the person has end stage disease then there are some choices that won’t be offered.
An Advanced Care Plan is preferably written down so it can be accessed if needed. It can be a letter but in Queensland the Statutory Form is the Advance Health Directive Form 4 Powers of Attorney Act 1998. Metro North and South Hospital and Health Services have produced a form called Statement of Choices which is easier to use. Form A is for persons with decision making capacity and Form B is for the Substitute decision Maker to complete. The hospitals are encouraging patients to complete the form with the help of their GP who needs to sign it saying the patient is capable of making the choices then this is uploaded to the viewer so the form is accessible in the public hospital system. There is another form for when patients are in an Aged Care Facility. These forms are available on the GPpartners website.
In the Advance Health Directive not all the boxes need to be ticked but the intent of the patient’s wishes need to be recorded. It is good for the patient to complete the second part of the form which is to nominate an enduring power of attorney. It is worth explaining to the patient that this person can only make decisions when the patient is not capable of making the decisions and that is usually determined by a medical person. This makes it a bit clearer who makes the decisions because a Substitute decision maker can also make decisions if a patient is unable to. A Substitute Decision Maker can be a spouse, relative, someone who has care of the person or close friend.
To make things more complicated even if a person has written in their Advanced Care Plan they do not want treatment under the law consent needs to be obtained to withhold or stop any proposed treatment that is medically indicated. Unfortunately this may mean a Substitute Decision Maker can say to continue treatment if the patient is unable to consent. If an AHD or Statement of Choices is available this may inform the decision.
It is not straight forward but at least if a patient has an Advanced Care Plan the patient’s wishes for end of life care are known and hopefully they won’t be subjected to unnecessary invasive procedures.
Dr Jayne Ingham, Chair