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Advance Care Planning Allied Health, Scientific and Technical Conference 2014

Advance Care Planning Allied Health, Scientific and Technical Conference 2014. Ian d’Young ACP P roject Manager Auckland District Health Board. $20.5 million!. Chance of winning 38 million to 1. Chance of dying guaranteed. Plan to cover:. What ACP is – Film

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Advance Care Planning Allied Health, Scientific and Technical Conference 2014

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  1. Advance Care PlanningAllied Health, Scientific and Technical Conference 2014 Ian d’Young ACP Project Manager Auckland District Health Board

  2. $20.5 million!

  3. Chance of winning 38 million to 1 • Chance of dying guaranteed

  4. Plan to cover: • What ACP is – Film • How ACP can change outcomes? • Why are we not doing it? • How are we overcoming the barriers • - Workforce education & training • - Public engagement • - Systems

  5. What is Advance Care Planning?

  6. What is Advance Care Planning? • What is it? • Who is it for? • What are the benefits: • For patients? • Families? • Healthcare workers? • System?

  7. Changing outcomes 61 year old woman Multiple comorbidities, services engaged Hx previous surgery, difficult recovery Admitted, blocked VP shunt, needs surgery Stable, unconscious Clear medical view of required course of action - surgery

  8. Changing outcomes

  9. Changing outcomes Last shunt surgery 2003 2004 clinic letter to GP – “would have refused medical treatment…” Last clinic note 6 months ago Unable to contact previous clinician or GP Lived alone and independent Family upset that you might do nothing and let her die

  10. Changing outcomes

  11. An Advance Care Plan is a record of a person’s wishes, preferences, values and goals relevant to future care and could include an advance directive

  12. Workforce barriers

  13. Workforce barriers

  14. Workforce barriers

  15. Consumer barriers What words would I use? Talking about death brings it on My doctor is trying so hard to fight this for me I am not dying yet I will upset my partner If I talk about it, it means I am giving up I don’t know enough about this My doctor is really busy I don’t understand some of these terms I am waiting for the doctor to raise it, he knows best

  16. Consumer barriers People are thinking about and touching on it in casual conversation Most don’t know they can influence the outcome They want healthcare workers to bring it up

  17. …and they want to talk about it early

  18. If something unexpected occurred, are there circumstances where you would prefer treatment to shift to comfort and natural death? Does person have an EPoA Diagnosis, acute episodes, decline in function Painting a picture of what the future might hold with regard to disease progression. Traditional ACP Person at risk of dying in the next 12 months Detailed Planning and documentation of treatment & care preferences Before a person is “diagnosed”, understanding what is important to the person and encouraging thinking about planning generally DIAGNOSIS and DISEASE MANAGEMENT EARLY AT RISK

  19. Consumer information resources:

  20. Engaging and educating the health workforce • Awareness and buy-in • Identifying clinical leaders • Skills assessment • Training

  21. Workforce Engagement and Training • LEVEL 3 • What skills and knowledge do I need to train the Level 2 course? • 17 day course • LEVEL 2 • What additional skills do I need to tackle more complicated situations? • 2 ½ day advanced course including comms training • LEVEL 1 • What do I need to know to start and continue a conversation about ACP? • 4 eLearning modules • BASIC • What is ACP and the benefits? • FILM

  22. Basic ACP Training - 2 Films Films with discussion - What is ACP, what is it NOT? - What are the benefits: For patients? Families? Healthcare workers? System? - Where can I find more information?

  23. Level 1 ACP Training – eLearning90 minutes self-directed learning Doing your own ACP (empathy building) Who could benefit from thinking, talking and planning for the future? Why are we not introducing it? How can we overcome the barriers and start a conversation? How do we record conversations? How can ACP change outcomes?

  24. www.advancecareplanning.org.nz

  25. L2 ACP Practitioner Trainingincluding advanced communication training

  26. Engaging the workforce

  27. Training Outcomes

  28. Training Outcomes

  29. Training Outcomes

  30. Training Outcomes

  31. Raising awareness with the public • Media • Communities and primary care • Accessible resources • Support for health workforce to answer queries • Myth-busting

  32. April 16th 2014

  33. Our Role? People only die once; they have no experience to draw upon. They need clinicians who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come. Gawande, A. (2010): Letting go, Annuls of Medicine, The New Yorker

  34. What do we need to do? Help people understand what the future might hold So they can be better prepared And we can be better informed to make decisions in their best interests

  35. Thank you Questions?

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