SCDHB focus on end of life planning
A doctor specialising in aged care is helping to change the culture in South Canterbury around helping people plan for the end of their life.
South Canterbury District Health Board (SCDHB) aged care consultant, Dr Stanley Smith, said the DHB was ahead of others in helping people with Advance Care Planning (ACP).
ACP encouraged people to discuss with their families what the future might hold for them, what sort of care they wanted in their later years, and the level of medical intervention they were happy with if they no longer had the ability to communicate their wishes.
One aspect of the process was people completing an Advance Care Directive, a legally binding document that outlined precisely how much medical care a person wanted if they fell ill or suffered a major medical event.
Smith said at the moment the hospital had a pink form, which simply asked a patient whether they wanted cardiopulmonary resuscitation (CPR).
‘‘Our CPR form ... the house officer is going to go, ‘do you want CPR?’ That’s probably going to be a bit threatening.
‘‘This idea of allowing a natural death is less confronting to people ... you might start with, have you done an Advance Directive, do you know what that is, if you have done one, let’s take a look at it, what does it say?
‘‘It’s about if you are in the hospital, if for some reason your heart stopped, would you want resuscitating, what are the risks, what are the benefits?
‘‘Some will be very quick , ‘oh, i don’t want you to do that to me’ and others will need some counselling. So of course for the house officers it’s time to ask about the Advance Directives, explain what the whole process is.’’
He said the success in the healthcare system was judged on how long you could prolong someone’s life, however that wasn’t always the case.
‘‘Just because you can keep someone alive doesn’t mean that you should.
‘‘People are happy to plan their funeral, you also need to plan the part before that. It’s a bit of a culture change.’’
Smith said the SCDHB had a ‘‘high number’’ of ACP’s being completed, putting it ahead of other health boards in New Zea- land.
He said making a plan took the burden away from a family having to make a difficult decision themselves.
Educating medical professionals in the hospital environment also supported nurses working in aged residential care, who worked one-to-one with people nearing the end of their lives, Smith said.
‘‘They are often the person with someone at two o’clock in the morning when nobody else is around, and that person is getting to realise things aren’t going well, and is willing to talk about the fact they might be dying and have they had enough of these aggressive treatments.
‘‘If that nurse is comfortable having that conversation that can be very helpful. I have seen the positive results of that.’’