ST 2 PALLIATIVE CARE

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ST 2 PALLIATIVE CARE ETHICS

• Niall Cameron
• Rosalie Dunn
• Alan Frame
• Anthea Martin
• Euan Paterson
• Janet Trundle

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Palliative Care and Ethics

• 0900 1000 Diagnosing dying Euan Paterson
• Anticipatory Care Planning
• 1000 1100 Symptom relief Janet Trundle
• 1115 1230 End of Life Ethics Niall
  Cameron
• 1230 1330 Lunch Dining with death
• 1330 1430 The Good Death Rosalie Dunn
• 1500 1630 Medico-legal Principles and
  Pitfalls Alan Frame
• Anthea Martin
• 1630 Feedback / Close

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Palliative Care and Ethics

• 0900 1000 Diagnosing dying Euan Paterson
• Anticipatory Care Planning
• 1000 1100 Symptom relief Janet Trundle
• 1115 1230 End of Life Ethics Niall
  Cameron
• 1330 1430 The Good Death Rosalie Dunn
• 1500 1630 Medico-legal Principles and
  Pitfalls Alan Frame
• Anthea Martin
• 1630 Feedback / Close

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Some all too common problems

• The sudden deterioration
• What does the patient know / think / want?
• What do the family know / think / want?
• Lack of medication
• Blue light 999 at end of life
• Who knows what?
• The weekend catastrophe
• The bad death
• and then 4 hours to confirm it happened!

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Anticipatory Care Planning (ACP)

• What is it?
• Why is it (possibly) more important in palliative
  care?
• Who is it for?

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Who is it for?

• Marla doesnt have testicular cancer. Marla
  doesnt have Tb. She isnt dying.
• Okay in that brainy brain-food philosophy way,
  were all dying, but Marla isnt dying the way
  Chloe is dying
• Chuck Palahniuk - Fight Club

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Numbers and Trajectories
GP has 20 deaths per list of 2000 patients
per year
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Diagnosing dying

• What primary disease do they suffer from?
• How are they at this moment?
• How rapidly are they changing?
• Would you be surprised?

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Who is it for?

• Patients with supportive / palliative care needs
• Whoever YOU feel should be included!
• Palliative care register
• GSF register
• SPICT / GSFS prognostication guidance?
• Chronic disease registers?
• Care Home patients??
• Housebound patients???

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Anticipatory Care Planning (ACP)

• What is it?
• Why is it (possibly) more important in palliative
  care?
• Who is it for?
• What does it entail?

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Anticipatory Care Planning
SPAR
Lanarkshire Home Care Pack
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Legal

• Capacity
• Welfare Power of Attorney
• Continuing Power of Attorney
• Guardianship
• Consent
• To record
• To transfer
• Advance decision to refuse treatment

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Clinical

• Consideration of potential problems
• What is likely to happen to THIS patient
• What might happen to THIS patient
• DNACPR
• Just in Case
• Proactive prescribing
• DN Verification of Expected Death
• Liverpool Care Pathway for the Dying
• Bereavement

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Patient / Personal

• Preferred priorities of care
• Place of care
• Place of death
• Admission?
• Aggressiveness of treatment
• What is wanted
• What is not wanted
• Who is to be involved

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The views and wishes of patient / carer

• My thinking ahead and making plans
• What is important to me just now
• Planning ahead
• Looking after me well
• My concerns
• Other important things
• Things I want to know more about
• Keeping track (who helped me)
• An advanced statement

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Patient / Personal

• Advance statement
• Statement of values
• E.g. what makes life worth living
• What patient wishes
• E.g. place of care, aggressiveness of treatment
• What patient does not want
• E.g. PEG feeding, SC fluids, CPR
• Who they would wish consulted
• Process
• Gathering
• Sensitive consultations discussion
• My Thinking Ahead Making Plans
• Recording

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Anticipatory Care Planning (ACP)

• What is it?
• Why is it (possibly) more important in palliative
  care?
• Who is it for?
• What does it entail?
• What is the process?
• When should this be done?
• Who should do it?
• How should it be done?
• How should it be shared?

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ACP Process

• When should this be done?
• At any time in life that seems appropriate
• Continuously
• Who should do it?
• By anyone with an appropriate relationship!
• How should it be done?
• My Thinking Ahead Making Plans
• Carefully
• Write it down
• How can it be shared?
• ePCS
• Other communication

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What is ePCS for?

• Information transfer
• In Hours GP gt OOH
• Primary Care gt AE / Acute Receiving Units
• Primary Care gt Scottish Ambulance Service
• Prompts for proactive care
• Anticipatory Care Planning
• All data stored in one place
• Structure for lists / meetings / etc
• Palliative care DES

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What does ePCS contain?

• Information upload
• Palliative Care review date
• Consent to share information
• Current situation
• Diagnoses
• Key personnel involved
• Carer details
• Current treatment
• Repeat
• Last 30 days Acute
• Patient carer understanding
• Diagnosis Prognosis

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What does ePCS contain?

• Future Care Plan
• Patient wishes (VISION)
• Preferred Place of Care
• Resuscitation status
• Additional drugs in house (Just in Case)
• Advice for OOH GP e.g.
• Contact own GP OOH
• GP willingness to sign death certificate
• Additional OOH information (KEY section) e.g.
• Patient wishes
• Starting Liverpool Care Pathway
• Etc

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The ACP Checklist

• Capacity
• Power of Attorney / Possible future problems?
• Have we considered
• What is likely what might happen to this
  patient?
• Where the patient would like to be cared for?
• CPR / DNACPR?
• OOH information transfer (ePCS)
• Have we considered the possible need for
• Anticipatory prescribing (Just in Case)
• RN Verification of Expected Death
• The Liverpool Care Pathway for the Dying
• The patient / carer view
• My Thinking Ahead Making Plans

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Palliative Care and Ethics

• 0900 1000 Diagnosing dying Euan Paterson
• Anticipatory Care Planning
• 1000 1100 Symptom relief Janet Trundle
• 1115 1230 End of Life Ethics Niall
  Cameron
• 1330 1430 The Good Death Rosalie Dunn
• 1500 1630 Medico-legal Principles and
  Pitfalls Alan Frame
• Anthea Martin
• 1630 Feedback / Close