by Dr Gill Turner and Dr Lizzie Vardon

Advanced care planning (ACP) is a broad term used by healthcare professionals, to try and understand and record a plan for how people would like to be cared for in the future.

Benjamin Franklin wrote to Jean-Baptiste Leroy in 1789 “In this world nothing can be said to be certain, except death and taxes.”  Unfortunately, we cannot do much about the taxes, but we can help ensure that each and every one of us has had the opportunity to consider how we would like to be cared for if our physical or mental health deteriorates. 

Unfortunately, whenever anyone talks about ‘planning for the future’ in the context of health care, there is a risk that one of several things happen. Sometimes the patient and their family starts to feel anxious as in ‘ I must be really bad if they are talking about dying’, sometimes everyone thinks  immediately that a difficult decision is being sought – usually about resuscitation and life support . Although, on some occasions, people feel really pleased that they are being asked for their view and opinions about their care in the future, their opinions can often come as a surprise to their families who had never previously had such conversations.

A common misconception is that ACP is focused solely on serious medical decisions such as Resuscitation.  In fact, ACP is about holistic and person centered wellbeing.  We should not be defined by the medical condition that we have been diagnosed with, but instead be treated as an individual with our own unique experiences, thoughts and aspirations. In this context,   we should consider planning for all aspects of our future to be prudent. There may come a time for any of us in future when, due to loss of mental capacity, we’re are not able to make some decisions for ourselves, so determining in advance those things that we feel important or feel strongly about and ensuring our families, doctors and those close to us know about it, will give us a voice in a worst case scenario. It might be useful to think of it along the same lines that we make wills regarding our finances and assets for when we have died, and yet, we don’t always think about a living or health will.  Nonetheless, some people may not want to plan for the future or find thinking about such things distressing; which is also ok none of this is compulsory

Some questions that can be useful to think about, and maybe write down your thoughts are:

What is important to you, and what makes you happy?  

It may be relationships, friends and family members.  It may be pets, or a hobby.  It may be that you would always want to have your hair and nails done how you like them, or to be clean shaven. It might be that if you were very unwell, and were in the last days of your life that you would want to be surrounded by familiar photographs, and have your favourite music playing.

What elements/aspects of care are important to you?

It may be that, where possible you would want a bath rather than a “strip wash”.  It may be, with regards to Parkinsons, that you would want to be “on” as much as possible at the cost of more dyskinesia at the time.  It may be important that you would want to have dignified care and management of your bowels and waterworks which could include a catheter.  It may be that   being  fed via a feeding tube would never be acceptable .  It might be that you wouldn’t want unnecessary tests and investigations that won’t make you feel any better.  It might be that you would want antibiotics for a chest infection, but that you wouldn’t want repeated intravenous courses which meant lots of needles.  It might be that if your body weakened such that cardio-pulmonary resuscitation, in the event of the heart stopping, did not bring you back to a meaningful quality of life, that you would want to be allowed to die  peacefully. 

Is there anything that you worry about, or fear happening in the future?

It might be how you would be able to communicate if you found it difficult to speak. It might be how you’d wash and dress ourselves.  It may be that you would prefer to die/pass away at home, or, in hospital.  It may be that you worry about who will look after the cat after you have gone.

If you feel that you would like to think about an Advanced Care Plan, you might find it helpful to talk through your thoughts with a loved one, family member, friends and carers.  If you feel that you would like to make a record of your wishes, or discuss your thoughts further, then please get in touch with the PD specialist nurse, or speak to one of the PD team at your next clinic appointment.  Alternatively, you could contact the care navigator at your local GP surgery.  Here are some links below that you might find of interest:

https://www.parkinsons.org.uk/professionals/resources/anticipatory-care-plan

www.compassionindying.org.uk

www.mydecisions.org.uk

www.nhs.uk/livewell/endoflifecare/documents/planning_your_future_care%5B1%5D.pdf

https://www.gov.uk/government/publications/make-a-lasting-power-of-attorney

Coates Center – in the grounds of Oakhaven Hospice.  Open to individuals and families/carers of those affected by a long term condition.  www.thecoatescentre.co.uk

RefNo Title
Recent Diagnosis  
B023 Recently diagnosed with Parkinson's? A guide to our information resources
B027 Information resources catalogue
L001 A quick introduction to Parkinson's 
FS48 Diagnosing Parkinson's
V012 New to Parkinson's? DVD
   
Families  
B086 My Gran has Parkinson's
B087 My Grandad has Parkinson's
B088 My Mum has Parkinson's
B089 My Dad has Parkinson's
FS66 Talking to children about Parkinson's
FS86 Does Parkinson's run in families?
B071 The carer's guide
B501 Information about Parkinson's (easy read)
   
   
   
   
   
Advanced Parkinson's  
B003 Thinking about advanced Parkinson's
B092 Preparing for end of life
FS33 Dementia and Lewy bodies
FS58 Parkinson's dementia
   
   
   
   
Research  
B118-17 Progress Magazine (Issue 17)
B118-18 Progress Magazine (Issue 18)
B118-20 Progress Magazine (Issue 20)
B118-21 Progress Magazine (Issue 21)
B118-22 Progress Magazine (Issue 22)
421 An introduction to taking part in research
   
Drug Treatment and Therapies  
B013 Drug treatments for Parkinson’s
B102 Complementary therapies and Parkinson's
B123 Surgery and Parkinson's
FS07 Speech and language therapy and Parkinson's
FS26 Apomorphine
FS42 Physiotherapy and Parkinson's
FS97 Occupational therapy and Parkinson's
   
Day to Day life  
B105B Get It On Time - Clock Poster A4 Laminated
   
B103 Work and Parkinson's
   
B145 Parkinson's medication record
B181 Parkinson's and you, including newly diagnosed resources guide (PKB023)
B181AUD Parkinson's and you - audio CD
B182 Going into hospital when you have Parkinson's
B011 Tips and hints
B077 Living with Parkinson's
B034 Intimate relationships and Parkinson's
B060 Looking after your bladder and bowels when you have Parkinson's
B064 Driving and Parkinson’s 
B065 Diet and Parkinson's
B070 Sleep and Parkinson's
FS06 Communication and Parkinson's
FS22 Eating, swallowing and saliva control in Parkinson's
   
FS28 International travel and Parkinson's
FS29 Living alone
FS39 Falls and Parkinson's
FS69 Monitoring your Parkinson's
FS50 Low blood pressure and Parkinson's
FS60 Using computers and the internet
FS77 Impulsive and compulsive behaviour in Parkinson's
   
   
   
   
Symptoms  
B117 Non-motor symptoms questionnaire
FS11 Hallucinations and delusions in Parkinson's
FS14 Parkinsonism
FS27 Eyes and Parkinson's
FS37 Pain in Parkinson's
FS40 Skin and sweating problems in Parkinson's
FS43 Muscle cramps and dystonia
FS51 Foot care and Parkinson's
FS56 Depression and Parkinson's
FS63 Freezing in Parkinson's
FS72 Fatigue and Parkinson's
FS73 Wearing off and involuntary movements (dyskinesia)
FS83 Restless legs syndrome
FS94 Tremor and Parkinson's
FS96 Anxiety and Parkinson's
   
   
   
   
   
   
   
   
   
FS70 Keeping a diary - for carers
FS71 Talking to your GP, specialist or Parkinson's nurse about Parkinson's
   
   
   
   
   
FS88 Talking to people about Parkinson's
   
FS95 Mild memory and thinking problems
   
   
FS98 Dental and oral health in Parkinson's
   
M001 Parkinson's medication card
   
Benefits  
WB01 General information about benefits
WB02 Attendance Allowance
WB03 Disability Living Allowance
WB05 Pension Credit
WB08 Carer's Allowance
WB09 Help with health costs
WB10 Help with getting around
WB12 Help with Council Tax
WB13 Housing Benefit
WB15 Grants and loans
WB16 Employment and Support Allowance
WB19 Jobseeker's Allowance
WB20 Personal Independence Payment
WB21 Universal Credit
WB22 Daily living equipment

 

 

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