Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly

Advance Care Planning :

Patients should be encouraged to give a copy of any written documents such as an Advance Statement to their doctor, other relevant healthcare provider, trusted family member or friend and to their solicitor.

 

Advance Statements should be reviewed as the patient's condition, and possibly treatment preferences, change.

 

Patients should be urged to communicate any changes in their Advance Statement to their GP provider and other relevant healthcare provider.

 

Doctors should record relevant discussions with the patient and any changes to the Advance Statement in the patient's medical record, including both the local health record (encompassing the practice as well as the hospital).

 

An advance statement - unlike an advance decision - is not legally binding, so doctors and medical professionals do not have to follow it. However, it should still be taken into account by health and social care professionals when making decisions about care and treatment.

Cultural and religious influences on decision-making

 

The UK is home to individuals of diverse culture, language and religion.

Respecting and being sensitive to people from diverse cultural and linguistic backgrounds and their community ties is integral to the delivery of quality care at the end of life (PCA, 2008).

 

Quality care at the end of life is realised when it is individualised to meet the person’s needs and upholds their preferences which are based on many factors, including individual cultural beliefs.

The basic values, principles and assumptions of Western medicine are themselves culturally determined and may not reflect the same values, principles and assumptions of patients from different cultural backgrounds.

 

Views may vary between cultures and religions on issues such as:

  • the preferred place of treatment;

  • communication of diagnosis and prognosis. For example, in certain cultures it is not appropriate to inform the patient of a ‘terminal’ diagnosis or to even discuss death;

  • the role of family/relative/friends in caring for the patient. For example, the designation of a decision-maker for medical treatment. In certain cultures, it is not customary for a competent patient to make their own treatment decisions, particularly regarding life-sustaining treatment;

  • the role of health professionals and volunteers, for example, whether or not they may be welcome in the home;

  • attitudes to pain relief, whether certain medicines are ‘taboo’;

  • attitudes to euthanasia;

  • ‘taboo’ words. For example, in certain cultures it is inappropriate to use ‘cancer’ or ‘death’;

  • handling of the body. For example, in certain cultures, only family members of the same sex as the deceased may handle the body;

  • the expression of grief and bereavement.

 

The process of dying, perhaps more than any other moment in the course of medical care, can accentuate cultural differences between patients, families, and providers (Krakauer E, 2002).

Quality care at the end of life is realised when strong networks exist between specialist palliative care providers, primary generalist, primary specialist and support care providers and the community – working together to meet the needs of all people.

 

The consequences of culturally inappropriate care can include psychological distress and unnecessary suffering for the patient, family, carers and community.

 

There can be issues with translators and medical interpreters where they do not feel able to honestly relay information due to their own cultural beliefs.

 

The needs of older people from culturally and linguistically diverse communities and new and emerging communities raise broad equity and access issues.

 

All health professionals must have a proactive engagement in culturally and linguistically diverse issues, and therefore need a level of cultural competence when caring for people from different cultural backgrounds and the knowledge of when and how to consult further cultural expertise when required.

Advance Statement Template

Template for the recording of Advance Care Planning decisions.

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Universal Form of Treatment Options

Template for the recording of Advance Care Planning decisions in the hospital setting.

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This topic is part of the Advance Care Planning domain of the

Comprehensive Geriatric Assessment

Advance Care Planning is one of 8 domains of the

Comprehensive Geriatric Assessment (CGA)

Advance Care Planning
Advance Care Planning
Advance Care Planning

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Comprehensive Geriatric Assessment
Comprehensive Geriatric Assessment
Comprehensive Geriatric Assessment

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Advance Statement

Advance Statement Template

Advance Statement Templat
Advance Statement Templat
Advance Statement Templat

 576 KB

UFTO

UFTO
UFTO
UFTO

284 KB

Challenges

 

Some patients may be treated in more than one clinical setting through the course of their illness including inpatient hospital care, aged care facilities, palliative care facilities, intensive care (including neonatal intensive care) and at home.

Quality care at the end of life is realised when strong networks exist between specialist palliative care providers, primary generalist, primary specialist and support care providers and the community – working together to meet the needs of all people.

Support should be given to the development of services that will meet the changing requirements in patient care and support continuity of care between clinical settings.

 

Where possible, the patient should be cared for in the environment of their choice.

 

There should be appropriate integration of General Practice and hospital care to improve patient outcomes through better clinical management, improved continuity of care and reduced readmissions.

High quality continuity of care requires that the care provided by hospitals be well coordinated with a patient’s General Practitioner and, where applicable, a patient’s residential aged care facility.

Universal Form of Treatment Options

 

A Universal Form of Treatment Options (UFTO) is available for use in Hospital settings.

 

Introducing the UFTO was associated with a significant reduction in harmful events in patients in whom a decision not to attempt CPR had been made. Coupled with supportive qualitative evidence, this indicates the UFTO improved care for this vulnerable group (Fritz Z, 2013).