Advanced care planning is usually in my mind from the first time that I meet a
person, and often I do only meet a person the one time or maybe once with a follow-up.
So in my mind I'm thinking about that person's care now, but also what
the possible trajectories might be into the future, and what their care may be,
and what's going to be really important for them. If I'm giving a person a diagnosis that
they haven't realized or is going to come as a shock then that's a big conversation in itself
and we may not go into advanced care planning in that conversation that may be something that..
Although we often even just started a little bit, just starting to think about the future.
And then making sure that I'm handing that over, handing the baton on to somebody else
which is, might be a family member who says yep this is really important, we'll work with mum
and generally back to their primary care, their general practitioner. The conversations need a time,
and time, and quiet, and calm so that person can think um, and feel safe,
and then be have a gentle conversation about thinking about what is important to them.
The nice thing in the New Zealand advanced care plan is that you've got those first main two
pages, which are really all about you and what's important to you that you can work through with
somebody and you know they're probably the most important pages in the plan. And being aware that
even if people are developing real changes in their brain or are on the journey of a dementia,
people know themselves and they know what's important to them and they can
express that for a long long long time and that's what you're really trying to get to.
And if you've got a person where you're not sure if they understand or can remember but
you have that conversation and then you have the same conversation again maybe they don't
remember the last one but they're consistently telling you the same things are important
and then you have it a third time and they're consistently telling you then you
can feel pretty comfortable that what they're telling you is what's really important to them.
So, the conversations that I have with people often are talking about the end of life so talking about
death, and if we're moving into what they want for themselves or sometimes with a very
disabled person talking mainly with the whānau, but if possible with everyone then, it's talking about
what will be important right at the very last stages of life and when they die.
In fact, sometimes that's where people want to start because it's quite a concrete thing
that they can think about, and sometimes people's fear their biggest fear
some people's biggest fear is dying but some people's biggest fear is
is losing their independence, and so you go to a place where they can manage the conversation,
and if they feel that I'll manage that then you can go to a different place in the conversation.
Thinking about whether a person still has the capacity, the mental capacity to make an advance
care plan. In my experience the majority of people who I meet have got the capacity to contribute to
and make an advance care plan that's giving them the time and opportunity and having somebody
walk along with them, and then write down, help them write down their answers or write down
their answers for them so that you end up with something written down because that's
the conversations are really important but the gift is when it's written down, and it can be
referred back to when it may be needed one day. So, the way to know whether somebody has the
capacity to write or work with someone to write an advanced care plan is to start along that path
because it will become apparent if that person really cannot stay in the moment
with the conversation at all, can't process at all what it is that you're talking about, gives
answers but they're not consistent. If it becomes really complex it might be that you that you're
wondering what's going on with this person's brain and you might want to refer to somebody like
myself and my colleagues to look into that further.
But, it's usually pretty apparent because after all you're talking about what is important to a person.