P-10 Advance care planning with patients with dementia

Abstract

Introduction Advance Care Planning (ACP) is high on the government’s agenda for all patients with life limiting illnesses. This is particularly difficult for patients with dementia due to the long and unpredictable illness trajectory affecting their capacity. ACP has been shown to have positive impact on end of life care and is important to ensuring that the patient voice is heard and removing burden from family members. Applying policy to practice however is challenging with confusion over which professionals are responsible for the role. Aims and Objectives The aim of the study was to determine which professionals are best placed to undergo ACP with patients with dementia. Health care professionals’ views and experience of the process were explored with regard to personal beliefs, professional roles and working practices. Method A qualitative approach was adopted using semi-structured interviews. These were recorded and transcribed verbatim and analysed using guidance from the Framework Method. Results 11 professionals were interviewed, representing a broad spectrum of multidisciplinary community healthcare practice. Two major themes were developed: ACP and working practices and combined complexities of dementia and ACP. Overall it was found that ACP with patients with dementia is complex and challenging, with numerous barriers to successfully implementing the process. Each professional group has different issues making this difficult. This therefore impacts on the concept of one group taking ownership of the process. Conclusion Which professionals should be responsible for the role remains unclear, with differing opinions as to whether it should be the role of one group of professionals, a new role or a shared responsibility. Barriers need to be overcome and use of the Gold Standard Framework needs to be more focused on patients with dementia early in the illness trajectory.