G_CS_11 Planning for Future Care Guidance: Advance Care Planning, Advance Decisions to Refuse Treatment & DNACPR

A number of policy initiatives have placed emphasis on enabling patient choice about their care, discussions around needs and preferences, information, and greater partnership working between health and social care for people approaching the end of life (DH 2001, DH 2005, DH 2006, DH 2007, DH 2008a, DH 2008b, DH 2010, DH 2011). In particular the National Institute for Clinical Excellence (NICE 2004) produced guidance for improving supportive and palliative care for adult cancer patients. Key areas recommended for improvement were assessment and discussion about a person’s physical, psychological, social, spiritual and financial support needs, and choice about treatment and services.

Care planning encompasses the care of people with and without capacity to make their own decisions. It involves a process of assessment and person centred dialogue to establish needs, preferences and goals of care, and making decisions about how to meet these in the context of available resources. It can be focused towards meeting immediate needs, as well as predicting future needs and making appropriate arrangements or contingency plans to address these.

Where a person lacks capacity to decide, care planning must focus on determining their best interests, through consultation with the person’s relatives and carers and key professional carers, and making decisions to protect these. Any information about what the person’s views might have been about the issue at hand, and any relevant advance statement that they made prior to their loss of capacity, should be taken into account when trying to work out what is in their best interests.

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