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Winter readiness presents opportunity to discuss advance care plans


Morgan Liotta


4/07/2022 3:22:20 PM

The RACGP has reminded GPs to discuss linking advance care plans with My Health Record when providing ‘catch-up’ care to older patients.

GP talking to elderly patient.
Winter is an opportune time for GPs to discuss advance care planning with patients.

Many GPs would likely already be familiar with the advantages of linking advance care planning documents with a patients’ My Health Record.
 
With older Australians being a priority group for flu vaccines, other catch-up vaccines and potentially missed episodes of care during the past two years, winter is an opportune time for GPs to discuss advance care planning with their patients and to let them know they can upload their advance care directive and details of their advanced care directive custodian to their My Health Record.
 
This is according to Associate Professor Joel Rhee, Chair of RACGP Specific Interests Cancer and Palliative Care, who told newsGP it is an ‘excellent opportunity’ as part of winter preparedness. 
 
‘The key message is that advance care planning is a process, and the hardest bit is just getting the conversation started,’ he said.
 
‘It’s often an elephant in the room, where both sides – patient and the doctor – are looking at each other to raise the issue first.’
 
Associate Professor Rhee said there are useful approaches for introducing advance care plans to patients during a routine consultation, while being mindful that certain processes or terminologies may vary across states and territories.
 
‘Approach it from a “Who will be making decisions for you if you are not able?” angle,’ he said.
 
‘I look up the patient’s next of kin in the practice records, and then I explain that the concept of “next of kin” is problematic. [For example] in New South Wales we use the term “person responsible’.
 
‘I then check whether the person listed as their “next of kin” would fit into the definition of “person responsible” in an unambiguous way. Sometimes they do, eg their spouse, but sometimes they do not, eg the person might want their second daughter to be the person responsible but they might have two other adult children.
 
‘I then explain that in the latter situation, then they are leaving it to chance.’
 
While some patients may be happy with this approach, Associate Professor Rhee said that many have a preference, in which case the patient should be advised to consider visiting their solicitor to appoint their preferred person as the enduring guardian – again being aware of terminologies and processes differing between jurisdictions.
 
Currently healthcare providers can upload a patient’s advance care planning documents or goals of care documents related to end-of-life care to their My Health Record if instructed by the patient. This requires the clinical software used by the health service to be configured to support this functionality, and practices are recommended to check with their software provider if unsure.
 
Patients can also upload a copy of their advance care directive to their My Health Record to make it available to all healthcare providers involved in their care, as well as add information about an advance care document custodian, a person or organisation chosen by the patient to hold copies of any advance care planning documents.
 
Including these details enables other healthcare providers to contact the patient’s custodian to discuss their preferences for care.
 
There are currently no general practice clinical information systems that have the functionality to upload a patient’s advance care planning documents to their My Health Record. GPs will
be able to upload these documents on behalf of the patient, with their consent, once this functionality is available.  
 
Associate Professor Rhee would welcome software changes that allow GPs to upload advance care plans for their patients, having previously told newsGP that while enabling patients to personally upload these documents into My Health Record is beneficial, expanding clinical software functionalities will enable more streamlined and accurate records.
 
In the meantime, he recommends that GPs continue to use winter vaccine catch-ups and routine care for older people as an opportunity to ask about their advance care plans.
 
The RACGP has supporting resources to provide general practices with guidance on incorporating advance care plans into their practice:

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Dr Kenneth John McCroary   5/07/2022 2:14:55 PM

Argh! ACD are not just for old people.