Advance care planning and discussions about it is not done in a 10 minute consultation
with the GP and very often, the most difficult thing for professionals and for everyone is
to know first of when to start it and secondly how to start it.
Very often that will be a process that changes and modified over quite a long period of time.
So there are an enormous amount of benefits for individuals and the family and carers
and friends as well as ourselves as health and social care professionals in discussing
advance care planning and finding out what people want for their future when they are
approaching the end of their lives. If we think about the individuals themselves
to start off with, we know it's beneficial to talk about fears and worries.
The unknown is always scary so if we can start to talk about what that might be like, it
reduces the potential anxiety that that person might experience.
For health professionals, we can feel much more job satisfaction by being able to talk
about and work with individuals as they approach the end of their lives rather than getting
to the end and maybe seeing someone die in a place that you knew that they didn't want
to be or in distress. I think there's a lot of reasons why health
and social care professionals avoid conversations about death and dying, end of life issues
and advance care planning. I think there is still a taboo, talking about
death. It's probably still something that most
of us still want to avoid facing as a reality. Partly because it's upsetting for them.
Especially if they've got a relationship with that individual.
A lot of people haven't received any training so their lacking in confidence perhaps and
competence. So they're not quite sure what they should
be doing. There is a whole raft of courses and workshops
available. Some of it within small groups, some of it
online but it's about recognising what their training needs are and actively going and
seeking some of that training. I was a doctor for almost 40 years before
I had my first training in advance care planning; now I've had 5 this year!
It's more beneficial in giving confidence to the healthcare professional to actively
start the consultation and there are certain techniques and skills in the communication
that are quite easily learned. One of the things that's really important
for health professionals is to identify the individuals who it's appropriate to start
talking about the future and advance care planning.
So part of that process is recognising the triggers.
So some of those cues might be non verbal so it might be around seeing an emotion and
then the verbal cues are around what people might be saying or how they might be behaving
and the questions that they might be asking. One of the key skills that health professionals
can use is to acknowledge what it is they're seeing or hearing.
So to acknowledge how upsetting the situation is or confusing or whatever it is that they�re
picking up. My partner Richard and I met about 10 years
ago. We had 8 fabulous years together and then
on Christmas day 2009, what we thought was migraine was diagnosed as a brain tumour.
When Richard was first diagnosed we were of course absolutely devastated and we didn�t
really know about this disease or understand the implications.
My Macmillan's nurse put me in touch with a palliative care consultant who came to the
house and assessed Richard's needs here at home and we were all signed up to getting
the very best quality of life for Richard. The focus was very much on keeping Richard
safe, keeping him comfortable, supporting him to enjoy the things that he could still
enjoy in life. All these professionals linked together with
one another seamlessly was fabulous sharing of information with the GP as well.
For Richard, definitely the care in the home was the best for him.
My wife was diagnosed with ovarian cancer in 2007.
She then had 3 operations, 4 bites of chemotherapy and she died in December 2011.
She would frequently ask the consultant how long she had to live and they would frequently
stall. No one wants to give that information.
Professionals have a real anxiety about having these conversations because they do worry
that they're going to upset the patient that they're going to cause them real grief.
But I don't think that's the case. I think evidence shows that the number of
people when these conversations have started actually feel better about it and want to
continue the conversation. And then, there's often a great relief with
the carers and the family of that patient because they've been having the same thoughts
and they know they're worried about it and they're worried about their loved one.
Interestingly, Linda did her own advance care planning.
She gave me two bits of advance care planning, advice!
Number one, she told me that I was far too young, that I would have to marry again!
Also, she gave me a list of suitable applicants! Thankfully none of them were married!
And then she told me not to get her the cheapest coffin.
I haven't made much progress on the former but at least I didn't do the latter!