The Beginning of the End

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					The Beginning of the End

    Workshop 27/05/2010
           Session Outline
• Talking to patients approaching the last
  year of life – is it important?
• What are the stumbling blocks?
• What would help? Use of documentation?
• Use of registers – GSF (current use and
  usefulness), locality registers – plans for
  the future……..
      Dying Matters Coalition
• Surveyed 1375 people
• 29% had discussed their wishes around
• 4% had written Advance Care Plans
• 68% were comfortable talking about death

• 70%+ want to die at home
• 60% currently die in hospital
               Carers’ quotes
• “It‟s not easy to talk about end of life issues, but
  it‟s important to do. Now that we‟ve put our
  affairs in order and are talking about what we
  want, we can „put that in a box‟ as it were, and
  get on with living one day at a time, cherishing
  each day together, as I know it‟s going to end
  one day.”

• “If you talk about dying, you can say everything
  you want or need to. There are no regrets.”
   Reasons for not discussing

• 45% said death feels a long way off
• 18% said they were too young to discuss
• Even 8% of 65-74 year olds thought they
  were too young to discuss dying.
               A GP view
• “As a practising GP, I know that many
  people feel frightened to talk about death
  for fear of upsetting the person they love.
  However, it is essential that people do not
  leave it until it is too late. Planning for
  needs and wishes helps you to be in
  control, and it helps those we leave
  behind. A good life needs a good ending.
  This can be achieved by talking about it
  early on with relatives, friends or carers”.
Advance Care Planning:
  What do we mean?
                         Advance Care

 General Care Planning


        Advance Care Planning
• Process of discussion between individual and care
• Makes clear person’s wishes in context of anticipated
  deterioration in condition
   – loss of capacity to make decision
   – Inability to communicate wishes to others
• Need patient’s permission to share
• Consideration re practicalities:
   – where to store written info
   – checking if decisions have changed
   – Documentation / written information
      • Planning for Your Future Care: A Guide
      • Preferred Priorities for Care
      • Advance Decision to Refuse Treatment
• Advance Statement               • Advance Decision to
                                    Refuse Treatment
   – Written by individual with
     capacity with support by         – Written by individual with
     professionals, family,             capacity with support by
     carers                             clinician
   – Covers wishes / beliefs          – Refusal of specific future
     re future care                     treatment in specific
   – Not legally binding but            circumstance
     take into account when           – Legally binding – must be
     acting in indiv’s best             written, signed, witnessed

• Do Not Attempt Cardiopulmonary Resuscitation
Completed by clinician with responsibility for patient (?others) –
patient’s permission if arrest anticipated and likely to be successful
Legally binding if part of ADRT, otherwise advisory only

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