Pandemic response should prioritise advance care planning, says report

A report released by Advance Care Planning Australia (ACPA) recommends that advance care planning (ACP) conversations should be happening now with older Australians and those with chronic conditions to avoid scenarios where people hospitalised with coronavirus who would rather forgo invasive treatment are not unnecessarily ‘competing’ with people who want it. ACP helps people advocate for the type of care they would want if they were unable to speak for themselves.

The report — Advance care planning in Australia during the COVID-19 outbreak: Now more important than ever — finds that ACP could be used as part of Australia’s response to the COVID-19 crisis by helping to manage surges in healthcare demand and reduce the need for rationing care.

The report reveals that 75% of older Australians do not have a plan to guide their treatment should they become suddenly unwell, meaning that decisions will be made for them.

Encouraging people to state their preferences and plan their care now means that individuals, their family and doctor are prepared when a health crisis occurs and the individual is no longer able to make their own treatment decisions.

At a policy level, the report recommends that the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) be updated to incorporate a more strategic approach to increasing system-wide ACP implementation. The plan currently contains just one vague reference to ACP, lacking detail about how it should be coordinated. The report identifies key recommendations for the health sector, including increasing health- and aged-care workforce competency in facilitating ACP, ensuring systems are in place to store and access ACP documents, such as My Health Record, and for GPs to make ACP conversations a routine part of care, which may be delivered via telehealth.

“Most of us expect to have a say in our medical treatment; however, when events change suddenly, people may be left without a voice or choice, if no plan is in place,” Adelaide-based GP and AMA Vice-President Dr Chris Moy said.

“I encourage all Australians, but particularly older people, and those with chronic illness such as heart disease or cancer, to talk to your doctor about your situation and preferences. A little planning today may save a lot of stress tomorrow.

“These conversations may make some people uneasy; however, as a GP, I know there are many people who feel strongly about being prepared and having their choices respected. They have the right to be heard,” Dr Moy said.

ACPA Program Director Linda Nolte said, “We know that the health- and aged-care workforce are under immense pressure right now. We’re here to support them with ACP advice and free online learning and resources.

”Whether you’re a GP, someone working in aged care or a person needing advance care planning advice, we’re here to help,” Nolte said, adding that ACPA operates a free National Advance Care Planning Advisory Service.

Key facts

• Almost 50% of people will not be able to make their own end-of-life medical decisions.¹
• Less than 15% of Australians have documented their preferences in an Advance Care Directive (ACD)² (25% of people aged 65+ have an ACD).³
• A third of Australians will die before the age of 75.⁴
• Most people die after a chronic illness, not a sudden event.³
• Research shows that ACP can reduce anxiety, depression and stress experienced by families and that they’re more likely to be satisfied with their loved one’s care.⁵
   

References

1. Silveira MJ, Kim SY and Langa KM. Advance directives and outcomes of surrogate decision making before death. New England Journal of Medicine. 2010; 362: 1211-8.
2. White B, Tilse C, Wilson J, et al. Prevalence and predictors of advance directives in Australia. Internal medicine journal. 2014; 44: 975-80.
3. Buck K, Detering Ket al. Prevalence and correlates of advance care directives among older Australians accessing health and residential agedcare services: multicentre audit study.
4. Australian Bureau of Statistics. Deaths, Australia, 2016. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3302.0(last accessed 17 April 2018).
5. Detering KM, Hancock AD, Reade MC and Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. 2010; 340: c1345.

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