Mina decides that she wants, as far as possible, to manage her conditions with medications and that she does not wish to have any invasive treatments or interventions. She appreciates that her heart failure and her COPD are not curable and are liable to progress. In NHS Scotland, planning for the future is normally referred to as Advance Care Planning. It involves talking about what you do or do not want to happen to you in the future regarding any care that you might need. The Good Life, Good Death, Good Grief website suggests that issues to think about are:
- granting power of attorney
- thinking about an Anticipatory Care Plan
- talking to your healthcare professional and those important to you about what you want in the future
- thinking about organ donation
- deciding on whether you want a DNACPR order implemented
- any medical treatments that you may not want
Advance care planning is the term most commonly referred to in end of life care, although it does incorporate the writing of wills or “Living Wills” now known as advance directives or advance decisions which can be done by the well person early on in life to plan for what may happen at the end of life. Anticipatory care planning is more commonly applied to support those living with a long term condition to plan for an expected change in health or social status. It also incorporates health improvement and staying well
(Scottish Government, 2010. Anticipatory Care Planning: Frequently Asked Questions).
As suggested by her SPARRA score (46%), Mina, her son and the Heart Failure Nurse draw up an Anticipatory Care Plan. Mina has read through the information on Advance and Anticipatory Care Planning provided by the nurse and knows what is involved.
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The Heart Failure Nurse visits Mina
Scene 1
HF NURSE: Did you get time to read the information leaflets that I gave you, Mina? Is there anything you would like me to go over with you?
MINA: Yes, I’ve had a good read of them and I think I am clear about what we are going to talk about today.
Scene 2
HF NURSE: You know that your heart failure has been getting worse recently and that it will progress. How do you feel about this?
Scene 3
MINA: I’ve had a good innings. I know that I am not going to get better and that my heart and my breathing are only going to get worse, despite the treatment. Like I said before, I definitely don’t want any treatments that might involve me going into hospital and leaving Joe but I am quite happy to take any tablets that might help. My only worry is that I’m getting very confused over which tablets to take and when to take them.
Scene 4
HF NURSE: We can ask the pharmacist whether he can do anything to help. You know that your disease is eventually going to be terminal – have you thought about where you might like to be when you reach the end of your life?
Scene 5
MINA: If Joe is still alive, then I would like to be cared for in the local hospice. A good friend of mine died in the hospice and the care she got was wonderful. I don’t want Joe to have to see me when I am nearing the end. If Joe goes before me, then I’d be happier seeing out my days in my own home.
Scene 6
HF NURSE: The leaflets that I gave you might have made you think about whether you want anything done if your heart gives out and you collapse suddenly. Have you thought about whether you would want to be treated, in this instance?
MINA: I have thought about this a lot and have decided that I don’t.
Scene 7
HF NURSE: What about appointing someone to speak up on your behalf if, for any reason, you are unable to do so yourself?
MINA: Joe obviously hasn’t the capacity to do this but Alistair and I have been to see my solicitor and we have organised for Alistair to have Power of Attorney. Alistair knows what I want.
Scene 8
MINA’S SON: I’m more than happy to do this for Mum and Dad.
Scene 9
HF NURSE: That’s excellent. Now, let’s have a chat about how we can plan ahead and think about how we can support you and Joe in the future.
Pulse point
Anticipatory and advance care planning are both about adopting a “thinking ahead” philosophy of care that allows practitioners and their teams to work with people and those close to them to set and achieve common goals that will ensure that the right thing is being done at the right time by the right person(s) with the right outcome (Scottish Government, 2010).
Good definitions can be found in the Scottish Palliative Care Guidelines and the British Heart Foundation’s Focus on…Multiple Health Conditions
Page last reviewed: 28 Sep 2020
