Advance planning critical for end-of-life dignity

Completing an Advance Care Plan with a GP should be as much a part of routine healthcare as breast screening or blood pressure checks, if we want to promote autonomy and dignity in end-of-life care, according to a Deakin University lecturer.

Senior Lecturer Dr Melissa Bloomer, from Deakin’s Centre for Quality and Patient Safety Research within the Institute for Health Transformation, said Australians were reluctant to talk about death and dying, which often led to challenging decision-making at the end of life.

But Dr Bloomer said completing an Advance Care Plan was a crucial way older Australians could have a say in the type of care they received, including where and how they died.

Advance Care Planning Week is this week and Dr Bloomer said with the concurrent public conversation around the Aged Care Royal Commission, it was the perfect opportunity to start discussions about the kind of care older people wanted to receive in later life.

“An Advance Care Plan gives a person the opportunity to record their values and priorities that could guide future care decisions, in the event the person is not able to voice their preferences for the type and extent of care they wish to receive,” Dr Bloomer said. “It can also guide decisions around the place of care or place of death.

“Important legislative changes introduced in Victoria last year mean whenever someone is admitted to a health service, the clinician is required to ask if they have an Advance Care Plan, ensure it is included as part of the person’s health record, and that the wishes and preferences are followed.”

Dr Bloomer said this legislation gave Advance Care Plans significant statutory recognition, an important step forward given her research from a decade ago that showed they were used by less than 1% of people admitted to health services.

A more recent study of Dr Bloomer’s into end-of-life care in hospitals, showed that data related to Advance Care Plans were so inconsistently recorded she was unable to make any assumptions about the frequency of their use. 

“It’s critical these forms are filled out by people while they’re still well and can make decisions about their future,” Dr Bloomer said.

“In an ideal world, all Australians would have conversations with their family about their wishes and preferences, then complete an Advance Care Plan (or Directive). Advance Care Plans should be discussed and completed routinely, perhaps as part of an annual check-up with the GP.”

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