Advanced Care Planning

Introducing Advance Care Planning (ACP)
As with many countries we have a real challenge in New Zealand in socialising the concept of Advance Care Planning and having open discussions about death and dying. Advance Care Planning (ACP) is a national strategic health priority that seeks to promote greater patient understanding and autonomy in decisions about end of life care, and mirrors work being done around the world in countries such as Australia and the United Kingdom.
Promoting value in shared discussion about future health care with the public is an important element in socialising the concept of ACP and challenging the language and social norms often associated with discussions around death and dying. Developing skills, capacity and resource for health professionals is equally important. Advance Care Planning Practitioner training has been developed by the New Zealand National ACP Cooperative and the Northern Regional Alliance and seeks to provide the necessary tools to enable clinicians to more confidently engage in what are often seen as difficult and challenging conversations around future health care with patients.
What is ACP?
ACP gives everyone a chance to say what is important to them. It helps people understand what the future might hold and to say what treatment they would and would not want. It helps people, their families and their healthcare teams plan for future and end of life care through a process of discussion and shared planning that is focused on the individual and involves both the person and the health care professionals responsible for their care.
ACP may also involve the person’s family/whanau and/or carers if that is the person’s wish. The planning process assists the individual to identify their personal beliefs and values and incorporate them into plans for their future health care. ACP provides individuals with the opportunity to develop and express their preferences for care informed not only by their personal beliefs and values but also by an understanding of their current and anticipated future health status and the treatment and care options available. The ACP process may result in the person choosing to write an advance care plan and/or an advance directive and/or to appoint an enduring power of attorney (EPA). If a person is identified as having strong views or preferences about medical treatments and procedures, they should be advised to consider completing an advance directive.
The value of the ACP process, however, lies not solely in these outcomes but in the conversations and the shared understanding that eventuate. This makes it much easier for families and healthcare providers to know what the person would want – particularly if they can no longer speak for themselves. Advance care planning discussions are an opportunity for health professionals to understand what is important to patients, what matters to them, and what makes life meaningful to them. This makes it easier for healthcare workers to make treatment and care decisions on their behalf, if and when the situation arises.
An advance care plan is the desired outcome of the ACP process. Ideally, it is documented rather than verbal and while this might be done on a form designed specifically for that purpose, it can be in any format. It should be accessible to current and future health care providers and to family/whanau members according to the person’s wishes. An advance care plan is not intended to be used only to direct future medical treatments and procedures when the person loses capacity to make their own decisions (becomes incompetent). An advance care plan can and should, however, be used to inform decision-making in this situation along with other measures such as discussions with the individual with an EPA (where one has been appointed) and with family/whanau.
Training and Further Information
Therapists are encouraged to commence ACP practitioner training by completing the free online level one e-learing modules. The level one Advance Care Planning (ACP) e-learning modules are designed to give a broad introduction to the rationale, structure and process involved in initiating an ACP conversation with clients. The modules explore the different elements of the ACP continuum including Advance Directives, Enduring Power of Attorney and Advance Care Plans. Modules are interactive, contain patient stories and practical examples and certification is available.
To learn more about ACP, watch our film where two people recount their true stories of their Advance Care Planning journey. For further information, or to complete the level one ACP practitioner training, visit our website at www.advancecareplanning.co.nz