Advanced care planning refers to the methodology that takes into assessment the goals, values, ideologies of person through exploration and documentation. This analysis helps the care giver decide and determine the care they must provide to the patient after they lose their decision-making abilities. Advanced care planning is extremely important for people with life limiting conditions but some patients might need priority initiation simply because of the urgency of their situation.
Bob is a 64 year old gentleman with motor neuron disease. He was diagnosed with same a year ago and has not been working since then. Bob used to be an electrician and his condition made his working conditions extra risky. Three months after the diagnosis Bob is getting a little serious. He is still able to work but he is experiencing weakness in his arms. To improve his social and physical functioning. Bob has been referred to a physiotherapist who find out that Bob is getting more and more speech difficulties and that’s affecting his mood as he is becoming aware of how his autonomy is shrinking.
In this essay we will be evaluating how the benefits of ACP can be helpful for Bob and Margaret. ACP will take the personality goals and value so Bob into consideration to evaluate how he can still exercise some autonomy and decision making as his condition continues to progress.
Understanding the trajectory of the disease in the first few stages of agency will help in calculating the extent of autonomy that Bob can exercise. Having the difficult discussion beforehand will help in the simplification of the troubles that the family and carers will face later. most of the literature on the subject of advanced planned caring shows how the planning will only support Bob’s fundamental right to exercise autonomy and self-determination.
The overall programme of ACP will help bob’s wife, family and carers to align with the clinical team and support his informed decision making (Stevenson & O’Donnell, 2015).Once Bob is able to fully understand and contextualize the role of ACP in his daily life, he will come more at ease with the condition of motor neuron diseases and much of his anxiety will go away as he will have the assistance of a team of highly qualified professionals. Following ACP. Bob will experience decreased stress levels and increased confidence in decision making that will also help him feel better informed about his preferences (Wasylynuk & Davison, 2015).
Supportive literature also shows how ACP can lead to decreased use of invasive life prolonging treatment that will only reduce the quality of life for Bob. Bob is an upstanding citizen who has a lot of regard for his own calibre, only the empathy of an ACP will give him the freedom of choice and understanding that he truly requires. The comfort-oriented treatment along with informal carers that will help him in his everyday activities but mot obsessively will be extremely satisfying and helpful for him and Margaret in the long run (Stevenson & O’Donnell, 2015).
ACP can be instrumental in alleviating the pain that comes with a difficult health condition and yet despite its crystal-clear benefits it’s not until the very last stages that the family or carer understands the significance of such a programme. Time is one of the most important factors and can help prevent major mishaps for elderly patients because by the time their state worsens, there is very little the doctors or medical professional can do to save them or add to their quality of life. The ideal step would be to follow in with a plan to get ACP after the initial diagnosis or acute deterioration (Mack et al., 2012).
It has been noticed that in most context clinicians are nervous or unsure about the initiation of ACP. Understanding the indication-based approach can be an extremely helpful step in deciding the initiation of ACP to allocate the resources and planned care in the most ideal manner (Green at al., 2015).
Most of the previous studies and outtakes in this field point towards early initiation of the ACP for bob while he still has considerable amount of autonomy to avoid any severe complications in the future. There is considerable amount of clinical stability present at the moment which will work in advantage for the carers and staff as they will be able to prepare for the unpredictable trajectory of the disease while still giving a sense of normalcy to Bob. In any case, prompt initiation of ACP coupled with a buffer phase that helps the carer and the patient get acquainted and familiar with process is advised to build confidence (Dingfield & Kayser, 2017).
ACP is an extremely complex and reflective process that needs input from the patient. In the initial stages of prognosis should be asked about his knowledge and understanding of his condition. The person-centred approach is underpinned by evidence-based technology. One of the most crucial steps in these early stages is to understand and get bob to speak about his values and goals and what he wants from his life (Lum, Sudore, & Bekelman, 2015). As mentioned before, the lack of independence and dependence eon others is what bothers him the most. So reflective approach that helps the carers understand Bob’s expectations from the whole process and one that gives him a comfort oriented yet fairly independent outlook to live peacefully should be the main objective.
Discussion of possible medical scenarios, prior wishes, steps to take in case of an emergency and instructional care are some of the other aspects that are factored in in this whole process that will let Bob not worry about the unpredictability of his condition. ACP is not a single even but a gradual and ongoing programme that is guided by the values of the patient and in this case the mindset and wishes of Bob, based on his clinical scenario. ACP for Bob will involve continuous assistance, discussion and aid indecision making process that will help him continue to live a life full of dignity(Tuck, Brod, Nutt, & Fromme, 2015).
The first main step ahead will involve the employment of an MDM for Bob who will guide him with the ACD form once his condition starts to deteriorate. Presently the ACD form used in Victoria is the Department of Health and Human Services’ ‘Advance care directive for adults’ (DHHS, 2018). It was developed from Victoria’s Medical Treatment Planning and Decisions Act (2016) and consists of 6 parts. The first part involves contextualizing the form by asking bob about his health problem and colleting the facts. The second part entails the formation of goals and value directive of bob that will guide the actions of the medical staff. The third part involves the instructional directive, an instructional directive is a legally binding medical decision made by the patient regarding their future care (Victoria’s Medical Treatment Planning and Decisions Act, 2016). Part four involves the declaration of the expiry date of the ACD and part five involves witnessing requirements for the from. If an interpreter was use din preparing the ACD, then the sixth part of the form will require the details of the interpreter. Most importantly, Bob and his family should be given the ‘Instructions for completing the Advance care directive for adults form’ (Austin Health, 2018) as the procedure and documentation for ACD can be a bit complicated and hard to decipher straight away.
The reviewing of the ACD is of paramount importance as it reflects the level of alignment between the form and Bob’s wishes and values. With regard to his context the review should be done every 6 months or at least once a year to see how he is responding to his changing health because then we will come to if the ACD needs to be changed. Technically, according to Victoria’s Medical Treatment Planning and Decisions Act (2016), the ACD is only activated when Bob can no longer take his decisions or carry out tasks independently. In his condition his increasing worsening abilities of speech are a matter of concern, so regular renewals where he is able to provide instruction and context are extremely necessary.
ACP is a really important part for a patient with a chronic illness as it ensures their value retention and autonomy over life and decision-making process. It gives them the opportunity to create a way of life that include their ideologies and instructions for future in case of unforeseen circumstances. In Bob’s case, introducing the ACP will only help him understand and explore his options and preferences and ease his anxiety in such uncertain situations. The aim of the ACP is to provide adequate help and assistance to Bob and his family, it is a complex process that should occur over time and in response to Bob and his changing health status.
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