P-40 Advance care planning – case studies show benefits for the young and healthy aged

Abstract

Background Barwon Health’s community implementation of Advance Care Planning (ACP) works collaboratively with General Practice (GP) conducting patient-centred, facilitator-led clinics. The majority of patients completing ACPs are over 75 years, however a small number are considerably younger, most often in the terminal phase of an illness. Aim To highlight the benefits of ACP in primary care, regardless of age and diagnosis, and evaluate whether expressed wishes matched the actual care received throughout the care continuum. Methods Evaluation of 3 case studies through document audits, including a young woman with metastatic Glioblastoma Multiforme, who was referred by her GP and completed her ACP in the clinic, twenty three days prior to death. Results Documentation at key intersections with a number of health service programs showed references to the ACP and respect for each patient’s expressed preferences. Discussion GP’s are in a privileged position to identify the needs of patients at different stages of life, and with varying diagnoses, to facilitate timely ACP discussion and completion. This empowers the patient wishing to maintain control over their future health choices and subsequently informs clinicians throughout the care continuum, regardless of where this care occurs. Conclusion Young people with a terminal illness and the healthy aged need access to ACP through primary care. Although initiating discussions and reflecting on death can be profoundly confronting and difficult, GPs are well positioned to initiate these discussions. Follow up by trained ACP Facilitators ensures timely completion of documentation which must be integrated and easily accessible to all treating clinicians.