Authors (including presenting author) :
Kan WY, Law CB, Yeung KM, Tang MKC, Yik WMJ, Cheung CCC, Poon YMM
Affiliation :
Department of Medicine & Geriatrics (M&G), Princess Margaret Hospital (PMH)
Introduction :
Advance care planning (ACP) is a proactive communication process to bring out the wish and preference regarding end-of-life (EOL) of a patient with advanced progressive disease. However, such a discussion in acute ward or busy outpatient clinic setting is not desirable for patient, family members and healthcare professionals with regard to individual’s readiness and consensus building. ACP clinic was established and pilot run in Department of M&G, PMH, to facilitate and improve advance care decision making for patients with foreseeable disease progression in a multi-disciplinary manner.
Objectives :
1. To initiate ACP discussion in a relatively unstressed environment. 2. To formulate an advance care plan with mutual understanding and agreement between patient, family and healthcare team with the use of standardized documents. 3. To better prepare patient and family for possible future deterioration of the patient’s condition.
Methodology :
Discharge planning coordinators (DPC) received training on EOL/palliative care and communication skills and assist in provision of quality EOL care in M&G, PMH since 2018. In collaboration with geriatricians, ACP clinic was established since April 2019. DPC team operates the clinic monthly and utilizes 1-1.5 hours for interview with each patient and family group in out-patient setting. DPC introduce the concept of ACP, provide information on patient’s prognosis and treatment options and the associated benefits, harms and risks, facilitate discussion and understanding on patient and family’s preferences and values, and summarize the context to reach a consensus among various parties. Details of the ACP discussion is documented in the standardized ACP form, and signed with confirmation by doctor and patient or family members. Advance Directive and/or standardized Do-Not-Attempt Cardiopulmonary Resuscitation (DNACPR) for Non-hospitalized Patient may also be used if deemed appropriate.
Result & Outcome :
A total of 25 patient and family groups were interviewed in ACP clinic with ACP discussion initiated, and 24 of them had completed the ACP process and signed the standardized documents to indicate patient’s advance care plan. Positive feedback was received from patients and family members for better understanding on possible disease progression and prognosis. The healthcare team was appreciated for providing effective patient-centered care and formulating patient’s ACP to achieve a ‘good death’ in patient’s last journey of life. Professional nursing image in EOL care is also established.
