About advance care planning
Advance care planning (ACP) involves patients thinking about and making decisions now to guide their future health care. Their plan will help guide the people who may need to make decisions and choices on their behalf in the future.
Planning ahead can mean:
- discussing health care and quality of life choices with those closest to them
- choosing and appointing an Enduring Power of Attorney(s)
- completing an Advance Health Directive
- writing down their values, beliefs and health care preferences in a Statement of Choices.
ACP often relates to care received at the end of your life, but even if a person is fit and healthy, it is never too early to plan their future health care. If a person has strong beliefs about what they want to happen in the future, it is particularly important to make their plans and wishes known now.
ACP is also relevant for children and young people with a life-limiting illness or condition.
Advance care planning is a completely voluntary process.
Role of health professionals in advance care planning
Advance care planning allows health professionals to understand and respect a person's future healthcare preferences for a time when they become seriously ill and unable to communicate for themselves.
All healthcare professionals have an important role to help with planning and ensuring people have choice in their care. You might want to start the conversation with someone or they might ask you about advance care planning in general or about the advance care planning forms available to them.
Ideally, advance care planning will result in a person's preferences being documented to help ensure these preferences are respected.
Advance care planning conversations should be routine and occur as part of a person’s ongoing healthcare plan.
Read more about:
- the roles and responsibilities of health professionals in advance care planning
- triggers for advance care planning (PELP Framework)
- embedding ACP using the Train-the-Trainer Guide.
ACP process
Health professionals can follow this process to assist patients with advance care planning.
Step 1: Discuss
Encourage your patient to think about:
- what’s important to them
- their current health conditions and the health outcomes they would find acceptable or unacceptable
- care options (now and into the future).
Patients should identify who they would trust to make decisions on their behalf if needed (substitute decision maker(s)) and discuss their preferences for care with their substitute decision maker(s), family and friends.
Step 2: Record
Encourage patients to record their preferences and decisions by completing one or more of the following Queensland advance care planning forms:
Patients can use the Advance Health Directive or Enduring Power of Attorney form to legally appoint an attorney. An attorney is someone who will make decisions for them and can be a family member, friend, or someone else they trust to act in their best interests.
Step 3: Share
Explain to patients they will need to keep their original documents.
Copies of their advance care planning documents can be shared with anyone who may need to be involved in decisions about their future care, for example:
- decision makers
- family
- close friends
- health care provider(s).
A copy/scan of completed advance care planning documents can be sent to the Statewide Office of Advance Care Planning via:
- Email: acp@health.qld.gov.au
- Fax: 1300 008 227
- Post: PO Box 2274, Runcorn 4113.
The Statewide Office of Advance Care Planning will review the document(s) and, if they meet the document requirements, upload them to their secure Queensland Health electronic hospital record. This means ACP documents can be easily accessed by clinicians involved in their care if and when they are needed.
They can also upload advance care planning document to their My Health Record.
Step 4: Review
Patients can make changes to their advance care planning documents at any time they have decision-making capacity to do so.
Encourage patients to review their advance care planning documents on a regular basis, especially when significant changes occur in their life, for example:
- when health, personal or living situation changes
- when preferences change
- if they wish to change who is appointed as their substitute decision-maker(s).
Each of these may be triggers for the person to review their preferences and update/share ACP documents accordingly.
Voluntary assisted dying
Access information and clinical guidelines for health professionals regarding advance care planning and voluntary assisted dying in Queensland.
A consumer factsheet is available regarding advance care planning and voluntary assisted dying in Queensland (PDF 313 kB).