Advance care planning

Thinking, talking and planning for your future healthcare.


Advance Care Planning (ACP) (PDF 853 KB) is the process of thinking about, discussing, and writing down your wishes about the type of medical care and treatment you want to receive in the future if you are not able to make your own decisions. A person creates an Advance Care Plan while they are still able to decide what they want in the future. An Advance Care Plan is done with the help of a health professional. This could be your GP, practice nurse, district nurse, medical social worker, cardiac, diabetes or respiratory specialist nurse, cancer nurse, hospice nurse or doctor.

It could also be seen as a gift for your family so that when it comes to making the ‘hard’ decisions they know what you want

Who is it for?

It's a good idea to think about ACP now, before you become seriously ill or injured and have those conversations with family/whanau and friends. It's especially important to think about and discuss ACP if you have a terminal condition, are very frail, or have strong opinions about how and where you are treated at the end of your life.

ACP is relevant and can be beneficial for everyone. However, having a plan should be a high priority for the following groups:

■ Those with a serious or terminal diagnosis
■ Those who are likely to lose their ability to communicate in the next five years; for example, patients with early signs of dementia.2
■ Older patients (65+ years).
■ Those who participate in extreme/ high-risk sports or other behaviours that increase the risk of experiencing a health crisis.

My Advance Care Plan

You may wish to complete an Advance Care Plan to document your preferences and wishes for healthcare at the end of your life. An Advance Care Plan can be completed with your family/whānau and loved ones and with the help of a health professional if you have any significant health conditions. A health professional can explain to you the details of medical treatments for the very ill or injured, and talk you through the benefits and risks of these treatments.

If you wish (recommended) you can request to have your ACP lodged on your electronic record, to be shared with other clinicians if and when it's needed (for example, if you are seriously injured or unwell and in hospital). A short form is also available.

It's very important that, if you make a plan, you give copies to your family/whanau and loved ones. You should also keep a copy somewhere that you and those who live with you know about, for example, with your enduring power of attorney document, will, and other important documents.
IMPORTANT - Your Advance Care Plan will only be used if you are not capable of making your own decisions and speaking for yourself.

Next steps

If you are thinking about ACP, you should take the following actions:

1. Read the ACP guide (PDF 853 KB). 

2. Spend some time thinking about what values and beliefs around end-of-life issues are important to you, and consider discussing this with your family/whanau and loved ones. Specific issues to consider include:

Do you have a strong preference about where you die?
Do you have any specific religious beliefs or spiritual issues?
What concerns or fears do you have regarding the end of your life?

Do you wish for your organs and/or tissues to be donated, if possible, when you die?

3. Print and fill of the Summary of my Advance Care Plan document and read through thoroughly. 

IMPORTANT

If you are making an appointment with your GP, let them know in advance that your appointment is for an ACP discussion. This will help to ensure that the appointment is long enough. It will also give your GP the chance to prepare before you arrive. Your ACP discussion with your GP might require more than one appointment. ACP is new to Taranaki, and not all general practice teams currently offer this service. Consider making a will and appointing an Enduring Power of Attorney (EPoA) . 

Filling out my Advance Care Plan

A Tairāwhiti Summary of my Advance Care Plan form has been developed. Feel free to print this form and complete it. Ideally, use a black pen, this ensures it is clearer when copies are made. You can access the summary of my Advance Care Plan by clicking here. 

The forms may ask for your NHI number. You may not know this number which is fine. Just ensure that your full name, date of birth and address is clearly written and correct.
Competency is a legal term meaning that you can fully understand the decisions you are making. If you don’t get a health professional to sign the form, other doctors might question your ability to make these decisions

I've finished my Advance Care Plan - now what?

Click here to see a chart which will show you the next steps

You will need to sign your Advance Care Plan document when it is finished and you are happy with it. Once signed by both yourself and the health professional who has been assisting you (this is optional) it is important to retain the original copy yourself and consider giving copies to your EPoA, lawyer, family/whānau, friend or neighbour. You can also complete a summary form this can be filed with your GP and on your hospital Notes Need to link this.

Once you have completed you ACP you will be given a fridge magnet to identify where your ACP is kept so that St John, family and friends know where to find your ACP if you are unable to tell them. You also have the option of having a front door sticker which says “I have an advance care plan”. This alerts ambulance staff to look on the fridge for the magnet to enable them to locate your ACP.

Making changes to your Advance Care Plan
If you wish to alter your 'Summary of my Advance Care Plan' document, you can simply print off another copy and complete the process above again. Be sure to destroy any old plans and ensure all copies with Drs, family / whānau or friends and hospital records are changed also.

For more information, you can visit the ACP website http://www.advancecareplanning.org.nz/ that has more information and resource

Contact us:
For all ACP queries email: heather.robertson@tdh.org.nz

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