For the past 10 years, Dr Graeme Crawford has worked as a Macmillan GP Facilitator in the North Down and Ards area of the South Eastern Health and Social Care Trust.
I am part of a Palliative Care Team involving a Consultant, specialist nurses and Allied Health Professionals (Physiotherapist, Occupational Therapist, Speech and Language Therapist and Dietician) who meet to discuss patients with palliative care needs. We also provide training to our professional colleagues in palliative and end of life care with an emphasis on forward planning to ensure a high level of care for patients and their carers.
My work has involved promoting advance care planning. This is a valuable tool for helping ensure those people who are approaching end of life with cancer and other life limiting illnesses are involved in decisions about the care they receive.
Advance care planning is used to help health and social care professionals act in accordance with the wishes of a patient who has lost capacity (when their condition has worsened to the extent where they are no longer able to make decisions or communicate their wishes).
Making plans about the future is important for anyone who is living with cancer or any other long-term condition. It is never certain how an individual’s condition will progress, or for how long they will be able to retain control of their decisions about what care they receive and where they receive it. I would also encourage anyone who does not have an illness to think ahead and consider making an advance care plan.
Unlike some other options for planning ahead (such as an Advance Directive to Refuse Treatment or Enduring Power of Attorney) an advance statement is not legally binding and is free to make. It is a voluntary process of discussion and review to help an individual who has capacity to anticipate how their condition may affect them in the future. If they wish, they can then set on record choices or decisions relating to their care and treatment and have the option of changing these later. In the event that the individual’s illness progresses and they lose capacity, professional and family carers can refer to the decisions recorded. The advance care plan will only be used if the person loses capacity.
Many of us are reluctant to consider a plan, hoping we will not need it. Illness may arise unexpectedly, as in cases of stroke, or gradually take away our ability to make decisions, as happens with dementia. Talking about the future is something we can all find difficult but planning ahead can have many benefits. It can initiate important decisions with family members, helping avoid later disagreements and reassuring family members that their loved one’s wishes influenced their care.
Macmillan and the Public Health Agency have published a free booklet “Your life and your choices: plan ahead”. It provides information and forms to help with various aspects of advance care planning, beginning with who to raise the subject with and what to say. People can refer to it for information on making a will, creating enduring power of attorney, organ donation and funeral planning.
If we record our wishes it is more likely that we will get the care that’s right for us. It gives us some control over our future.