Background Advance care planning (ACP) is becoming part of routine care in most chronic, life limiting conditions. Barriers to implementation in the dialysis unit include lack of privacy, and the perception of singling people out for an ‘end of lifecare’ discussion. Few patients have robust plans in place.
Aim To normalise the process of ACP and embed it into unit practice for dialysis patients; improve uptake of ACP and identify substitute decision maker; ensure current plans are valid, and evaluate patient satisfaction by questionnaire.
Methods Nurse champions, the Nurse Practitioner and the social worker speak to each patient in the dialysis unit every six months and offer the hospital ACP brochure with a brief discussion and explanation of the process. The social worker incorporates ACP into discussions with patients who have complex needs. Prior to each ACP review, staff meet to allocate patient contacts and a record is kept of discussions and outcomes. A questionnaire was used to solicit patient feedback regarding the process.
Results Patients are more familiar with the process of ACP and comfortable with the regular presentation of information. Some avail themselves of the formal ACP process and/or appoint a Medical Power of Attorney.
Discussion The identity of substitute decision makers and facilitation of discussion within families has been a key outcome of this process.
Conclusion Linking ACP with other routine events (regular blood tests) in the dialysis unit has made the process more palatable and provides information to be drawn on at need.
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