Advance Care Planning in Australia - Essay Example

Advanced care for cancer patients Introduction Advance care planning in Australia is widely acknowledged as an important aspect of personalised care of those people nearing death. Accommodation and recognition of preferences and requirements contained in the advanced care planning document gives individuals the freedom to control the level and quality of the health care they receive when nearing death (Fried, &Drickamer, 2010). Improvements in the medical knowledge, over the past few decades, have led to the possibility of extending some patients’ lives. In regards to this, concerns have been raised about focusing less on the patient, and more on technology (Shanley, Whitmore, Conforti, Masso, Jayasinghe, & Griffiths, 2010). This is still combined with the assumptions of the community that the wishes of individual’s future health care should be respected. This presumption is very strong in cases where there is a loss of cognitive ability, which interferes with their capacity of decision making (Department of Health and Ageing, 2010). There are policies in place which requires the individual’s wishes to be respected, but implementing them and advanced care planning is sometimes impossible and challenging(Department of Health, 2007). The challenges are brought about by staffing, time issues, as well as space issues, but significant results can be achieved in residential aged care facilities (General Medical Council, 2010). Advanced care planning, can in a way prolong the lives of individuals, and many people fear this since they argue that this will prolong their suffering, as well as compromising their dignity and their quality of life. This paper will address the policy pertaining advanced care directives, strategy for implementing the strategy, the critique of implementing these policies, as well as future recommendations for implementing the policies pertaining advanced care directives for cancer patients. End- of life care for cancer patients Whenever the health of a cancer patient cannot be controlled anymore, cancer treatment and medication is often stopped, and the patient is left to rely on advanced care (National Cancer Institute). The aim of the advanced care is to improve the quality of life of the patient with the loved ones, as well as making the remaining months or weeks comfortable for the patient. Advanced health care decisions that are planned in advance, give the carers and family members a chance to respect choices and decisions while being aware of the individual’s beliefs, as well as how the system works (Temel, Greer, Muzikansky, Gallagher, et al., 2010). Even if no person expects to lose their cognitive control, most people, especially the older people with chronic diseases like cancer, are always in comfort and consoled by the fact that their family members or friends who are trusted can make the necessary decisions on their behalf. There is need for incorporating advanced care plan into general routine practice for cancer patients (Royal College of Physicians, 2008). This is because, the policy of the dying with dignity and having the wishes of individuals to be respected, requires the GPOs and care givers to develop trusted and on- going relationship with the cancer patients they are taking care of, so as to be in a position of initiating and promoting advanced care planning (Association for Palliative Medicine, 2009). Advanced care is the epitome of individual centred care, responding to challenges presented by the ageing population with chronic illnesses and people dying from cancer, and contemporary health care in Australia (Detering, Hancock, Reade, &Silvester, 2010). Even if there are some government and state laws in Australia that vary on advance health directives as well as advanced care planning, in every territory or state in Australia, advance care directives in a way are legally binding documents (Department of Health, 2009). Policy pertaining to advanced care directives Patients suffering from chronic cancer are always aware of their condition, if it is getting better, or deteriorating. In most cases these patients know that they do not have long to live, so are the aged people with terminal and chronic illnesses (Weissman&Mier, 2011). Therefore, most people always plan for their advanced care depending on their preferences to be followed in case they cannot make decisions on their own. Research shows that a person suffering from advanced cancer discusses the possible options with a doctor early enough, the stress level of the patient is decreased and the level of coping is increased. There are policies pertaining to the directives given by the individuals (Royal College of General Practitioners, 2009). The policy of dying with dignity, whereby, the patient, even having lost the cognitive ability, can be taken care of in a manner chosen and preferred by the individual or trusted friends or family members (Austin Health, Melbourne Australia, 2013). This gives the individual dignity when dying as other people’s wishes are not imposed on him or her when they cannot make decisions pertaining their lives and care. There is the policy of following and respecting the decision and directives of an individual in end- of life care. This calls for total respect and full implementation of the directives given by an individual. Following all the directives of the individual and implementing them, is the only way in Australia, that quality advanced care is believed to have been accorded to an individual in end of life care (White, Willmot&Trowse et al., 2010). Strategies for implementation There have been many strategies that have been put in place so as to achieve the advanced care planning for cancer patients in the country (Thompson-Hill,Hookey,Salt,& O'Neill, 2009). These strategies include that the policy makers integrate the policy into the existing health care plans so as to make it not look new. This is beneficial to the health personnel and the patients themselves. The reason behind this is that the health personnel will practice the policy as they are used in implementing the already existing health care plans (Weissman&Mier, 2011). This will help them to have confidence to fully implement the strategy. To the patient integration means that there is nothing new that will be introduced to them but there will be improvements to promote the policy. Every year, an estimation of 106,000 new cancer cases are diagnosed in Australia (NHMRC, 2012). There has also been the strategy of consultation support for the healthcare facility. This has helped the policy implementers to have limited opposition in putting the policy in working because everyone at the implementation stage feels part of the policy. This makes them work towards its success (Shanley, Whitmore, Conforti, Masso, Jayasinghe, & Griffiths, 2010). The strategy also works to ensure that all the stakeholders have been consulted and have their say about the advanced care planning. This helps in getting the experiences and point of views of the cancer patients themselves. This helps to incorporate the needs and views of the majority and to minimize on any resistance that could arise if people feel the policy is being forced on them (Schickedanz, Schillinger, &Landefeld, 2008). Research of cancer in Australia uses a lot of the country’s research funds, having used $215 million in 2000-01, amounting to 18% of the total research expenditure in Australia (NHMRC, 2012). Another strategy that has been used in the implementation of the advanced care planning for cancer patients is that the organization governing body has offered instrumental support to ensure that the policy has been a success. The governing body has gone to great heights to ensure that the policy is operational and its achieving its set objectives(Gray, 2011). This is by providing all the necessary resources such as the financial support and the information that could help achieve the set goals (NHMRC, 2012). Cancer in Australia takes 5.7% of the health system costs, which is $2.7 billion. The governing body has also been on negotiations with other health stakeholders to help incorporate the policy into other existing health care plans. This has been of great help because it has helped improve the policy together with the existing ones. The governing body has also invested heavily on research that will help provide the best policy work will achieve the set objectives in the efficient way possible (Rosenwax, McNamara, Murray, McCabe, Aoun,&Currow, 2011). Another strategy has been to lobby for leadership from those in power, the clinical and medical leaders and the nursing managers. This strategy works to ensure that the stakeholders are aware of such a policy for example NHMRC which is the main funder of cancer in the whole of Australia, having given more than $ 175 million for research in 2011. This will help put in place the policy because it will be leading from the front. Having these stakeholders lead in the implementation of the policy means that even those who are the actual implementers of the policy will see it necessary because their leaders are in support of the policy (Gundersen Lutheran Medical Foundation, 2011). This will help in fast implementation because these leaders will explain in depth to their juniors the need to have such policy in place (Gray, 2011). There has been a strategy to invest in education and skills development. The policy makers have ensured that they have ensured that there has been education on the policy through incorporation of the policy in the current health education system. This has helped develop the knowledge and skills required in implementing the policy(Innes & Payne 2009). This will help in that the health practitioners will need to go for extra studies on how to implement the policy it will incorporated in their actual training. To the policy makers the strategy to have the policy incorporated in the education system will develop the required knowledge about the policy and how to implement it. The policy makers have also ensured that the policy is in accordance with the law. The legality of the policy has been of great help in its implementation(Schickedanz, Schillinger, &Landefeld, 2008). There has also been research and development to help change the traditional system to fit the growing changes and needs of the people. This has been done to incorporate the changes occurring in the human life and in the legal context. The reason behind investing in education is that in there has been research that the failure of past policies has majorly been from the reluctances of the medical personnel because they are not knowledgeable about the policies (Thompson-Hill,Hookey,Salt,& O'Neill, 2009). This makes it hard for them to educate the patients on the policies. Therefore, building the confidence of the medical personnel is a key strategy to the success of the advanced health care policy. There has also been a strategy to ensure that there is no stress in the implementation process. In many health practices and policy there has been a lot of documentation that frustrates the system users. This policy has few documents that are required and this means that the process is very fast and short(Department of Health, 2008). Most of the stakeholders in the health sector in the past could avoid processes that could involve a lot of documentation this led to opposition to various policies that were put in place. Therefore, the fewer documents a system has, the more users friendly this is to the stakeholders (Innes & Payne 2009). The care givers of cancer patients encourage them to complete advance directives which state the wishes of patients for care. Research shows that cancer patients prefer to have an honest and open conversation with their doctors and care givers about the choices they have for the end- of – life care. Critique of implementing the policy Advance care planning is usually referred to as end –of –life care, and in Australia, this type of care has been developed in regard to governance, extensive range of funding, operational as well as organisational models(Keating, Landrum, & Rogers et al, 2010). However, research shows that the impact caused by these approaches, which are diverse, to health care and service delivery on individual patient’s experiences as well as outcomes have not really been understood or even well known (Department of Health and Ageing, 2010). This advance care giving process assists people suffering from advanced cancer, in making and planning as well as communicating their wishes regarding the care they receive in case they are incapacitated and impaired in future (Keating, Landrum, & Rogers et al, 2010). In Australia, there are almost 500, 000 primary carers, 2.6 million carers, and this adds up to close to 1.2 billion of hours that in used in care, annually. Estimations show that 76% of the services rendered to people requiring support and care, are provided by carers. With the ageing population in Australia being on the rise, as well as the population of the people living with advanced cancer (106,000 new cases being discovered each year), the proportion of the people who will be requiring advanced care is expected to rise(Schickedanz, Schillinger, &Landefeld, 2008). As much as the advanced care policy asks for respect of an individual’s decisions and dying with dignity, some decision are not covered by the law like euthanasia in order to end unbearable and prolonged plain and suffering, which is not a part and parcel of palliative care practice (Thompson-Hill,Hookey,Salt,& O'Neill, 2009). Discussions and decision about euthanasia are normally hindered by the failure of a society to provide access and unlimited quality care for the people nearing the end of their lives, in which, the rights of the people to clear the requests and decision of their care, are considered and respected (Royal College of Physicians, 2008). Another hindrance is the fact that, open and frank discussion about death and dying are rarely discussed in our society, and in most cases being termed as a closed discussion (Temel, Greer, Muzikansky, Gallagher, et al., 2010). In Australia, it is believed that quality advance care and quality palliative care is provided to an individual at the end of the life, when an individual’s decisions and preferences, which in most cases are influence by , and based on factors like cultural and individual beliefs, are followed to the letter (White, Willmot&Trowse et al., 2010).The carers always want to follow the policies of dying with dignity as well as respecting the wishes of the individuals, but they are always restricted from implementing these directives by the inconsistency in legislations on advanced care (Munday, Petrova,& Dale, 2009). Sometimes, the carers may follow a certain directive and due to the legislative inconsistency all over Australia, they may the criminally liable, as well is the carers who fail to follow the directives (Royal College of General Practitioners, 2009). Prior discussion and documentation of an individual’s preferences and wishes about their end- of life care leaves the family members and the carers in a better position, since there would be no arguments or disagreement about the care a person should be accorded (Department of Health Victoria, 2011). Hospice programs are the most effective for cancer patients since they are most coordinated. Recommendation The fact that inconsistencies in Australia’s legislations regarding advanced care lead to failure in implementing care directives, in order to stop the confusion about the rights and responsibilities of the treating staff in regard to directives, the government of Australia should promote policies and legislations uniformity nationally(Temel, Greer, Muzikansky, Gallagher, et al., 2010). The policies and legislations should be made uniform nationally concerning the implementation of advanced care directives and plans. Conclusion Most people would like to die with dignity as well as have their wishes and preferences respected and followed (Shanley, Whitmore, Conforti, Masso, Jayasinghe, & Griffiths, 2010). However, the policies and directives may not be easily implemented as some preferences or wishes may not be in line with the national legislations, or they may compromise the carer’s code of ethics (Weissman&Mier, 2011). Therefore, there is need for community education where people should be trained on how to make good decisions and preferences pertaining their care, which are in line with the legislations of their region. Future recommendation for advance care plan for cancer patients should be made in advance so as to incorporate the care givers and family members into the plan (National cancer institute, 2012). Making decisions and letting them be known by the family members and the carers works well in reducing and preventing conflicts due to conflicting decisions (Rosenwax, McNamara, Murray, McCabe, Aoun,&Currow, 2011).This also helps in preventing the individual from making decisions and directives that are hard to implement, as advice is given in accordance to the existing legislations(Royal College of Physicians, 2008). Incorporating all the teams involved in the end –of –life care goes along way in providing quality advanced care for a person (Department of Health Victoria, 2011). Again, talking over with the cancer patient about the possible options of care and the condition of his or her health, helps them reduce stress and cope easily. References Association for Palliative Medicine. (2009). Position statement on advance care planning. APM Newsletter, 31:3. Austin Health, Melbourne, Australia. 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