Abstract

Our hospice has developed a model of advance care planning support that helps patients to explore what they want to do and how to achieve it. This has resulted in their wishes and preferences being met including achieving their preferred place of death.

The model takes a partnership approach between the clinicians at the hospice and the patients they support, helping them consider choices and preferences for future care and treatment. Those clinicians can then refer in to the hospice’s advance care planning service where a social work assistant supports the person to write an Advance Statement and record their wishes. The patient holds a copy and anyone else as appropriate and consented to by them. The service supports patients who want to write an Advance Decision to Refuse Treatment as well. They talk to a doctor or nurse who knows them well so to be sure that they understand any potential implications of declining treatments.

The documents are reviewed every six months unless the person wants to make changes before or a review is prompted in some other way. Records indicate when reviews are due and documents are updated and disseminated again if required.

This has proved to be a more fluid and efficient system in providing this kind of support as it relieves the clinicians of the administrative elements of writing, storing and disseminating the documents.

If the patient wants to register a Lasting Power Attorney (LPA) the social work team manager can act as certificate provider for their applications. Although anyone can register LPAs via the Office of the Public Guardian, many people are either referred to, or seek the help of solicitors which can be costly. The service provides equitable access for those are unsure how to register or unable to afford.