Now is the time for advance care planning with patients

IT’S National Advance Care Planning Week and there is no better time to engage with patients and their loved ones about future health care wishes.

Over recent years, the global COVID-19 pandemic along with the impact of extreme weather events and natural disasters have reminded us of our vulnerability to sudden health events, and the limitations of our health, aged and social care systems. Providing quality care for our ageing population will call on health care professionals to assist patients and their loved ones in making decisions in the context of this uncertainty.

Advance care planning is a person-centred process, in which patients can discuss their future health care wishes with family members, health care professionals and trusted others. These discussions may lead patients to document their wishes, specifying future treatment preferences or identifying one or more substitute decision makers. Across all Australian states and territories, people with decision-making capacity are able to legally document their wishes in advance care directives.

Advance care planning is not just a one-off event, or something that is only suitable for people with deteriorating health. Ideally it starts early, and is an ongoing process. However, it is recommended that advance care planning conversations are prioritised for anyone who:

• has an advanced chronic illness, life-limiting condition or new significant diagnosis;
• is at a key point in their illness trajectory (e.g. planning or assessment for aged care services, or during transition to residential care);
• has declining ability to make their own decisions (e.g. a progressive cognitive impairment);
• in the view of a clinician who knows them well, may be likely to die in the next 12 months.

While advance care planning is associated with a range of benefits for patients, family members and the health care system, a recent national study led by Advance Care Planning Australia found that only 14% of older adults (aged 65 years or older) had advance care directives available in the health records held by their hospital, aged care home or GP clinic. While the prevalence of advance care directives was highest in the residential aged care setting, it was also common to see advance care planning documents completed for the person by someone else. Such documents have uncertain legal status and can be problematic to implement.

Given that almost one in three people will be unable to make their own medical decisions at the end of their lives, it is important that people have access to timely information and assistance to express their wishes for future health care, if they choose to do so.

The medical workforce plays a vital role

While advance care planning is first and foremost a person-centred process, and one that can benefit from input from a range of professions, doctors play an important role. As trusted providers of health care information, medical staff can help patients to understand their current health state and likely future scenarios that may emerge. They can work to understand their patients’ goals and values for future treatment, and inform patients about the types of treatment options that will help them achieve their goals.

They can coordinate multidisciplinary approaches to care, which may include referrals to allied health professionals or specialist palliative care providers. They can provide guidance for patients who wish to document their treatment preferences, including through witnessing advance care directives and assisting with storing and communicating these documents.

Once advance care planning documents are stored (eg, by the patient uploading it to their My Health Record) medical staff can have timely access to this information and act on the patient’s wishes if needed in a medical emergency. Importantly, doctors can also provide support and guidance for those who are nominated as substitute decision makers to ensure that the patient’s wishes and preferences are upheld.

Resources are available

Many states and territories provide locally relevant information about the requirements for advance care directives and the roles and responsibilities of substitute decision makers. You can access advance care planning resources that are relevant for your state or territory here.

National Advance Care Planning Week, 21–27 March, is an ideal time to engage with these resources, and consider how meaningful conversations about a patient’s future health care wishes might be beneficial, not just for them, but for everyone involved in providing care. Head to the referral page to refer your patient or carer to the free National Advance Care Planning Support Service.

Dr Craig Sinclair is a Postdoctoral Fellow in the School of Psychology at UNSW Sydney. He has an ongoing collaboration with Advance Care Planning Australia and is also an Associate Board Member of Advance Care Planning International.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.