1. Advance care planning

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6. Who’s who?

7. Background to Advanced Care
Planning
Hilary Squire
Clinical Nurse Specialist
Hospiscare

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14. References
• The cancer Plan (DoH, 2000).
• The Cancer Reform Strategy(DoH, 2007).
• Advanced Care Planning: A guide for Health &
Social Care Staff (2007) at:
http//www.endoflifecareforadults.nhs.uk
• The End of Life Strategy (DoH, 2008).
• Dying Matters Coalition GP Project NCPC
(2010) at http//www.dyingmatters.org

15. Strategies in Instigating an ACP
Annie Hunneyball
Clinical Nurse Specialist
Hospiscare

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18. Cancer
High
Function
GP’s Workload
Ave 20 Deaths per GP per year
Low
Time
Organ Failure
High
Function
Low
Time
Fraility/Dementia
High
Function
Low
Time

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24. References
• Advance Care Planning: A guide for Health &
Social Care Staff (2007) at :http//
www.endoflifecareforadults.nhs.uk
• Gold Standard Framework Prognostic Indicator
Guidance (2008) at:
http//www.goldstandardsframework.nhs.uk
• The End of Life Strategy (2008) Department of
Health, at: http//www.DoH.gov.uk

25. ADVANCED CARE PLANNING
Caroline Prince
Clinical nurse specialist
Hospiscare

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31. Advance Decision to Refuse
Treatment
Dr Jane Whitehurst
Macmillan GP Facilitator for Exeter and Mid Devon
Specialty Doctor Hospiscare

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41. Valid ADRT
• I now have MND and benefit from PEG
feeding. As my condition deteriorates, if I
should lose consciousness and am not
expected to recover after 24hrs, I wish
feeding, hydration and any other life
prolonging treatment such as antibiotics to be
withdrawn or withheld although medication
such as painkillers for my immediate comfort
can be used. This decision to apply even if my
life is at risk”

42. Valid ADRTs
I wish to refuse the following In these circumstances:-
specific treatments:-
Artificial (mechanical) breathing If I have had a severe stroke with
machine little chance of recovering
consciousness
Antibiotics If my dementia means that I cannot
not make the decision, in the event
that I have a severe chest infection
that might threaten my life.
Artificial feeding (via a tube or drip) When my dementia has
deteriorated to the point that I
cannot swallow safely, even with
the help of others

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• or intentionally shorten a
patients life

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47. Core Competencies for ACP

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49. Last night, my husband and I were sitting in the
living room and I said to him, 'I never want to live in
a vegetative state, dependent on some machine
and fluids from a bottle’.
He got up, unplugged the computer, and threw out my
wine.

51. Mrs Adams
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52. Mr Brown
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53. Mrs Carter
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54. Mr Downham
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56. This is my favorite recipe. It was
Granny's. Now you are the
guardian

57. “This is a book that I am really
going to miss. Think of me
whenever you read it

58. Here is my favourite joke. Dad left
it to me, now you must keep it alive

59. Thank you for this memory. I
treasure it.

60. I always wanted to tell you this but
was too shy/afraid/embarrassed.

61. I can’t remember if I told you this
before but.....

62. There is something I have learned
that I would like you to know

63. If you watch this film, think of me.
It was my favourite.

64. Have you ever thought about
trying....I reckon you would be
great at it