By Susan Gately - 23 May, 2014
Patients are willing to consider and record to their detailed preferences regarding their own end-of-life care according to a recent publication in the The Irish Medical Journal (IMJ).
The General Practice based study entitled Are We Ready to “Think Ahead”? Acceptability Study Using an Innovative End of Life Planning Tool involved 100 clinically stable patients in five GP Training Practices attending their GP for routine care.
The patients were given a Think Ahead form and asked to fill it out.
Later during a telephone survey, they shared their feelings on the experience of thinking about and putting to paper, their preferences about end of life care.
Think Ahead is a citizen-led advance planning tool which has been developed by the National Council of the Forum on End of Life in Ireland – an initiative of the Irish Hospice Foundation.
It guides people in looking at and recording all aspects of end of life: legal, economic, healthcare preferences and wishes for organ donation and funeral arrangements.
The survey found that almost three-quarters did not find not find completing the form upsetting. Over 60% had no difficulty filling it in. Most filled in all or part, and 87% agreed that the document should be made more widely available.
Significantly, having completed the form, over 80% of the patients had discussions at home with their families about end of life planning.
“Our study has found that the GP surgery is a good location to introduce end-of-life conversations, and a planning tool such as Think Ahead is invaluable,” said Dr O’Shea, lecturer in General Practice at Trinity College, and author of the study.
“Our study found high levels of acceptability and positive experience for most patients. The form itself was effective in encouraging discussions on end-of-life issues with family.”
Think Ahead was developed following a year-long public consultation process where people said they wanted a tool of this kind.
“It is continually being tested to ensure that it is meeting the needs of the public,” commented Sharon Foley, CEO of the Irish Hospice Foundation.
The form, which is available from the Irish Hospice Foundation or can be downloaded from www.thinkahead.ie, provides for an Advance Healthcare Directive.
Advanced Healthcare Directive
Sometimes known as ‘Living Wills’, Advanced Care Directives enable adults with capacity to make a legally binding decisions in relation to end of life care, and to refuse any form of treatment up to and including life-sustaining treatment.
This is not euthanasia or assisted suicide, which are and continue to be illegal in Ireland.
Instead an Advance Healthcare Directive is a method of obtaining consent for treatment in advance.
Advance Healthcare Directives are recognised in Common Law, but new legislation will put them on a statutory footing.
Under planned legislation, a person aged 18 and over who has capacity can prepare an Advance Healthcare Directive.
Their decisions on future medical treatment must be put in writing and be witnessed.
The document can be revoked at any time, verbally or in writing. There is no obligation to create an Advance Healthcare Directive and when one exists, it only comes into force after a person has lost capacity and cannot make a decision.
If there is doubt about an Advance Healthcare Directive, a person can go to the courts.
The Assisted Decision Making (Capacity) Bill 2013 which contains these provisions is currently making its way through the Dáil.
