Advance care planning allows people to clearly express their values and preferences to inform clinical decision-making when they are unable to directly participate.
In Victoria, an Advance care directive is the only legally recognised document that a person can record their medical treatment preferences in. However, should a person lose decision making capacity, any written record of their values or medical preferences must be considered by their medical treatment decision maker.
What form does the planning take?
Ideally advanced care planning should be an ongoing process of verbal and written communication, in order to strengthen its influence on clinical decision-making. Advance care planning includes:
- expressing personal values and preferences for treatment and care through conversations with family, friends and health practitioners.
- documenting these values and preferences in an advance care directive.
- appointing a medical treatment decision maker.
Conversation and communication
Advance care planning is an approach to communication in which a person can discuss goals, values and choices about their preferred outcomes of care.
It puts the person at the centre of care, involving them, their family (if appropriate) and the clinicians responsible for their care.
In advance care planning discussion with family members, clinicians and/or significant others, the person can convey their preferences for future care.
These preferences can then be documented in an advance care directive, which health practitioners can turn to if a person loses their capacity to make medical treatment decisions.
Who is advance care planning for?
Priority groups that would benefit from help in articulating their wishes for future treatment and care include:
- aged or older people who are frail
- people of any age with chronic progressive and life-limiting conditions
- people approaching end of life
- people with multiple comorbidities and/or at risk of conditions such as stroke or heart failure
- people with early cognitive impairment
- people who are isolated or vulnerable.
Benefits of advance care planning
Advance care planning has been shown to improve quality of care at the end of life and increase the likelihood of a person’s wishes being known and respected, for example:
- clients and families report greater satisfaction with the end-of-life care provided
- surviving family members report reduced levels of anxiety, depression and post-traumatic stress.
Advance care planning has benefits for the health practitioner and the broader health service system. These include:
- supporting better client outcomes
- assisting clinicians to provide person-centred care.
What advance care planning is not
Advance care planning highlights several separate but related treatment issues. As a result, its role and purpose can be confused with other decision-making, legal and communication concerns. Advance care planning is not:
- a substitute for good informed consent about current treatment options (although discussing the values and potential health outcomes of these may help decisions to be made)
- a tool for distributing fair and equitable healthcare resources across the wider community
- a replacement for clinical face-to-face communication and engagement.