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Advanced Care Planning in Hospitals
The evolution of Austin health's ‘Statement of Choices’
  1. L Jackson,
  2. K Detering,
  3. W Silvester and
  4. A Hancock
  1. Respecting Patient Choices, Austin Health, Melbourne

Abstract

Background The Respecting Patient Choices team has been doing advance care planning since 2002. We encourage people to nominate a substitute decision maker (SDM) and document their health care wishes on a ‘Statement of Choices’ (SOC). This document has evolved and now includes four components to ensure that the written plans are understood and appropriately acted upon by doctors.

They are:

  1. to record a person's wishes about future medical treatment based on their goals, values and beliefs.

  2. to record this information in a language that doctors would recognise and could act upon.

  3. be easy to fill in.

  4. to provide prompts for people facilitating the ACP conversation.

Aim To evaluate the evolution of the SOC.

Methods A retrospective audit of SOC completed in 2010.

Results Most people (70%) choose to nominate a SDM and complete a SOC. People generally nominate a family member as their SDM and the majority (>90%) indicate on their SOC that they ‘would not want CPR even if the doctors think it could be beneficial’ and ‘do not want life prolonging treatment (LPT) at all’. 25% provided guidance on what would be an ‘acceptable outcome’. The SOC is recognised by the doctors and is acted upon.

Conclusions

  • Austin Health has devised a SOC form that enables people to record their medical treatment preferences especially in relation to CPR and LPT.

  • The SOC is being further evolved for specific chronic conditions (eg, dialysis).

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