Defined by the Institute of Medicine as “Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions,” patient-centred care is now regarded as a cornerstone of optimal health care. The real test that clinicians are delivering “patient centred care” is not when the patient is strong, well, educated and able to advocate for him/herself but when the patient is weak, unwell and has lost the capacity or will to consider and communicate his/her goals, values and treatment preferences. A normalised, systemised, recognised and flexible advance care planning (ACP) process is the best way to ensure that the individual patient’s goals, values and treatment preferences are considered, identified, discussed and documented by the patient (while they have the capacity and desire to do so) and then communicated to, sought by, considered and complied with by the treating clinicians when important decisions are being made.
Even the act of an ACP discussion frequently highlights to the competent patient their rights, their autonomy and the existence of shared decision-making so that they are truly partners in their own care. This still applies in different cultures where the decision-making may not follow the Anglo-Saxon stereotype. Finally, the implementation of a correctly structured, holistic, systematised ACP program catalyses healthcare culture change that ensures that care is centred on the patient, not the family, not the clinician and not the organisation.
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