When is the right time for advance care planning discussions?
The right time is when you feel ready. This will be different for everyone.
This might be:
• if you are in poor health
• have a new diagnosis
• an admission to hospital
• a long-term health condition getting worse
Whose job is it to start the conversation?
Anyone can start an advance care planning conversation. If you are thinking about it, discuss this with a person important to you and/or a health care professional such as a nurse or doctor who can offer support with the process.
Before the conversation
Plan: Think about what you would like to discuss before you meet. Write this down or share it with someone important to you.
Make sure you are in the right frame of mind: this may depend on how you are feeling on the day. You might change your mind and that is okay.
Decide who you would like to talk to: this might be a doctor or nurse that you know and trust. Maybe a nurse who visits you at home.
Bring someone important to you to join the conversation. They can help you talk through your wishes, and it will be useful for them to know what you want.
Starting the conversation
You might feel nervous before having an advance care planning conversation. This is normal as sensitive topics are discussed.
It might feel hard to know how to start the conversation. Here are some suggestions to help you get started.
You could say:
I have been thinking about the future and what matters to me if my health gets worse and I would like to talk about it with you – person making a plan
The nurse/doctor seems concerned that your health is getting worse – do you think it’s worth talking about what you would like to happen in the future – person of importance
If the person is not ready, they can say no but asking a question sensitively might encourage them to start thinking about what’s important to them.
It might also be helpful to consider the process as a joint activity, where both a person receiving care and their close support (such as a partner, friend or caregiver) discuss and complete their plans together.
Having the conversation
Advance care planning can happen over many conversations. They can happen casually at any time with someone important to you or conversations can be formal. Formal conversations are usually organised with the health care staff who provide care (for example, a community nurse) and/or legal professionals (who might be needed to provide information on making a will or a power of attorney.
If you are unsure about something or would like more information don’t be afraid to ask. There is no such thing as a silly question when having these conversations.
Remember: You can stop the conversation at any time if you feel anxious or uncomfortable.
Recording and sharing the advance care planning
Once a plan has been made, it will be shared with health and social care colleagues involved in providing care. This will be done via paper and electronic records to ensure everyone has access to it including:
Out-of-hours care providers
Community health professionals
GP
Ambulance and emergency services
Advance care plans are stored safely and securely and will not be looked at unless there is a health or care related reason to or it requires a review.
Advance care plan for someone with a cognitive impairment
Cognitive impairment is a condition which affects a person’s mental abilities such as their memory and thinking. This includes Dementia, a stroke or brain injury. If you are planning an advance care planning conversation with someone important to you who has a cognitive impairment, then you should do the following:
1. Include the person in the conversation as much as possible.
2. Speak slowly.
3. Ask short questions and give them time to answer.
4. Talk about what is important to the person and their health.
5. Repeat back what you think they have said.
6. Look to see if they are upset or worried about any part of the conversation.
7. Be clear and use words that the person will understand.
With thanks to Dr Karen Harrison-Dening, Dementia UK.
Respecting everyone in the advance care planning process
No one should assume they know what a person’s wishes are based on their gender, ethnicity, sexual orientation, cultural or religious background.