Date Published: 19 February 2009

New guidelines will help patients plan their future care

Most people say they want to be able to plan their future health care in the event of them losing mental capacity, but very few people have made specific plans or documents that will enable healthcare professionals to know their choices.

New national concise guidelines 'Advance Care Planning' (ACP) from a variety of organisations show healthcare professionals how, when and where to discuss these issues with patients. It also explains how to document choices if the patient wants to record them, particularly if they want to record an advance decision to refuse treatment (ADRT), formerly known as a living will or advance directive.

The advance decisions only come into force if someone loses capacity, and do not override the decisions of someone who is still competent to make them. Discussions about advance care planning may lead to:

• An advance statement (a statement of wishes and preferences)
• An advance decision to refuse treatment, ADRT, which is a specific refusal of treatment(s) in a pre-defined potential future situation
• The appointment of a personal welfare Lasting Power of Attorney (LPA), someone who is empowered to make decisions on that person's behalf should they become incapacitated

The focus of the guidelines is to help healthcare professionals guide patients through the process, which is defined as a process with stages rather than being a single event, to allow for the patient to change their mind, whilst at the same time being sensitive to the patient's views and beliefs.

The guidelines include useful checklists for healthcare professionals on making valid clinical decisions, tips for a successful ACP discussion, suggested content for an ACP document, and an algorithm for helping patients make best interest decisions. The guidelines comply with and refer to the Mental Capacity Act 2005 and its code of practice so that healthcare professionals can refer to the source documents for further information.

Lead author of the document Dr Simon Conroy, a Senior Lecturer and Geriatrician, representing the British Geriatrics Society, said:

"There is now a major emphasis on advance care planning and a growing openness about end of life care more generally in the NHS. But it is important to remember that ACP is not for everyone and should not be forced upon individuals. We hope that these guidelines will help professionals to help the public in ensuring their wishes are respected in circumstances when they are unable to express themselves. The key points from the guidelines are that ACP is a process, can be complex, and to be effective should involve health care professionals. Effective ACP also requires different organisations working closely together, for example, by using shared documentation and having excellent communication between sectors."

Neil Hunt, Chief Executive of the Alzheimer's Society, said:

"An early diagnosis of dementia allows an individual to begin to plan for the future while they have capacity. This can bring some reassurance to a person worried about their future care and treatment. One in three people over 65 will die with dementia. Advance care planning is a complex area and people often need the support of health professionals so these new guidelines are a welcome new resource."

Dr Jonathan Waite, consultant psychogeriatrician and member of the Royal College of Psychiatrists' Faculty of Old Age Psychiatry, said:

"Advanced Care Plans are important for users of psychiatric services, especially where it is likely that they will not be able to make decisions about their care when they become ill. The Royal College of Psychiatrists is pleased to have had the opportunity to contribute to the development of these practical and helpful guidelines and to ensure that the perspectives of people with mental disorder - particularly those in the early stages of dementia - have been considered."

Janet Davies, Executive Director of Nursing and Service Delivery at the Royal College of Nursing said:

"These guidelines will be a useful tool for all healthcare professionals involved in advance care planning, which can be a complex process to navigate. Setting out the best times and places to discuss these sensitive issues with patients will help nurses and other healthcare professionals to ensure best practice prevails."

News is included to inform but not to endorse any particular view or activity. Any views expressed in this article are not necessarily those of IvyRose Ltd.. At least some of the material in this news item was released by the Royal College of Nursing (RCN) on or about 19 February 2009. This article might also include material from other sources, such as further comments, explanations and images credited individually.