Advanced Care Practice to Ensure Better End-Of-Life to All Patients Who Are Old Aged and Have Lost Their Ability to Make Rational Decisions - Essay Example

Advanced Care Practice Name Institution Advance care practice Introduction Advance care planning (ACP) is the reflection, communication and the discussion of the future treatment of a patient (Rhee, Zwar, & Kemp, 2013). The advance care plan is established for use by a patient in the event that he or she loses his competence to make a sound judgment. ACP plays a major role in the delivery of high-quality healthcare services to the old aged patients because it is a patient-based method of treatment. The use of ACP helps in the promotion of the values, the goals and the beliefs of a patient, and it involves the health care providers, the patient and the family members of the patient. Therefore, the ACP is aimed at ensuring the supply of appropriate treatment with dignity and of less suffering towards the end of the life of an old aged patient. Despite the medical advantages associated with advance care planning, there is still low uptake of ACP in Australia. There is also evidence that the advance care plans established by patients and their family members are not implemented by the health care providers in Australia. This paper is going to provide an analysis of policies of advance care directives and a critique of their implementation practice among old aged patients with cancer in Australia. Advance care directives The ACP is established on the principles of nursing practice, for example, the principle of non-maleficence and that of autonomy (Rhee, Zwar, & Kemp, 2013). In the process of making an advance care planning of a patient, Advance Care Directives (ACDs) are used. These are documents that are filled by an individual while he or she is still able to make informed judgment and decision regarding his future treatment and in the event the he loses his ability to make competent decision. Therefore, they are considered legal documents that direct the process of decision making. They are also used to appoint the surrogate decision makers for a patient. The primary ACD documents are the Durable Power of Attorney for Health Care (DPAHC or Health Care Proxy) and the Living Will (LW) (Rhee, Zwar, & Kemp, 2013). The durable power of Attorney Health Care is legal document that a patient signed in order to authorise another individual (surrogate) to make medical decision for him in the event that he loses his ability to make decisions. On the other hand, a living will is a document that summarises the patient’s preferred type of medical care when he loses his capacity to make decision in due to illness in old age (Dolansky & Moore, 2013). A living will is used when an old aged person becomes sick and shows no sign of recovery. The contents of a living will outline the guidelines for the resuscitation or the life support that should be offered to a patient. These include guidelines on the patient’s preferred hospitalisation, treatments, pain control, and other interventions like the chemotherapy among the patients of cancer (Productive Commission, 2013). It is encouraged that all patients who are old aged should complete an advance care directive early in their lives. This is because it helps in promoting the autonomy of the patient during the end-of-life care. Analysis of advance care directives Following the definition given above, advance care planning involves consultation with their family members, friends and health professionals to make a decision that regarding the future care of an old aged patient (Rhee, Zwar, & Kemp, 2013). This practice is gaining prominence in Australia and across the globe because it supports the autonomy of the patient in the decision-making process. It is also important because it provides a good end –of-life care for an old aged patient. Despite the advantages associated with it, research shows that the healthcare providers in Australia do not fully embrace the ACP and ACD requirements while handling old aged patients who have lost their rational judgment. Besides, the literature shows that there are problems in the implementation. In many cases, there are many patients who fill and complete the advance care plans supported by advanced care directives, however, the health care practitioners who are expected to deliver the treatment as indicated by the patient in the advance care plan, do not play their responsibility as expected. In many cases, the primary care providers neglect their patients. The major point of differences in these scenarios is the conflict between the values of the care providers and the advance care plan as indicated by the involved patient. It is normally the wish of the patient to have a dignified end-of-life. Similarly, it is the wish of the family members of the patient to see their member taken through a palliative care even to the final minutes of life (Crawford & Brown, 2011). However, on many occasions, the care providers don not see the sense of subjecting a patient to a treatment procedure that will not help bring the back to life. These have led to the painful end of life among old aged cancer patients who had well-constructed ACP. a. ACP uptake An analysis of the implementation of ACP among the old aged patients with cancer in Australia reveals that the low level of uptake of ACP in the country is one of the major issues affecting the efforts of advance care planning (Lachman, 2010). Firstly, a high percentage of patients do not want to engage in the process of ACP citing personal issues. This makes it difficult for the health care providers and their family members to develop an ACP for one who is not willing to get involved in the process. Secondly, there is widespread ignorance concerning the ACP. The majority of cancer patients in Australia lack awareness and the understanding of ACP (Rhee, Zwar, & Kemp, 2013). Besides, most people are reluctant to talk about issues concerning the end-of-life. The reluctance to talk about end-of-life is prevalent among most families and even among the health care providers themselves. This poses a major challenge because if no one is willing to address such issue, the affected patient will not be comfortable to take the initiative of discussing how he/she would like to be treated during his final days of life. Research works in this field shows that the majority of health care providers lack the appropriate training and the required experience to address the issues surround the end-life-life. They also do not have enough time to hold conversations with the relevant parties regarding this issue, hence, the low level of ACP uptake. To improve the ACP uptake, the barriers hindering the uptake of ACP should be handled (Rowlands, & Callen, Westbrook, 2012). Concerning this, the health care sector of Australia that is handling cancer patients should create an environment that encourages an open discussion on issues regarding the end-of-life care (Sternberg, 2012). To achieve this, awareness of the importance of advance care planning should be created among the general members of the public. Another method of facilitating the uptake of ACP among the old age cancer patients in Australia is to incorporate the implementation of ACP in all hospitals and residential homes that specialise in providing health care services to the aged patients with cancer. Barriers to the uptake of ACP such as lack of training and lack of inexperience in handling end-to-life conversion among health care providers in the country should also be solved by providing appropriate and relevant training to the primary care providers. This should be done through education and training through workshops within these settings. The involved health care providers should also make use of standardised forms and workbooks as resources to improve their skills. b. The implementation of advance care plans Another major worrying issue in the handling of the old aged cancer patients in Australia is the lack of the implementation of the ACP plans (Rhee, Zwar, & Kemp, 2013). Despite the formulation and the establishment of ACPs by patients and their family members, the resulting ACPs are not normally executed by the health care providers in charge of the patients. The reasons for not implementing the already in place ACPs is due to the lack of standardised electronic systems of medical records to allow the retrieval of the stored ACPs in a timely manner when they are needed (Reed & Shearer, 2011). Another contributor to the lack of implementation is the lack of continuity in the provision of health care service by professionals, for example, in the residential facilities that are taking care of the aged cancer patients (Sollecito & Johnson, 2013). Despite this, the ACP may be available may be available, but the available health care providers are not able to interpret it accordingly. It is even worse when the involved care providers do ignore the requirements of the ACP and use their own treatment procedures that cause pain to the patients (Macha & McDonough, 2012). Research also reveals that the ACPs fail to be implemented because of the uncertainties that involve the attempt to predict and make future plans (Rhee, Zwar, & Kemp, 2013). In such situations, it is advisable for the involved care provider to make use of the available ACP as a guideline in the making of decisions between the care providers and the family of the patient and in providing treatment, and not as a binding directive in the process (Moore & Tenbrunsel, 2013). If used in this way, there are some unforeseen considerations which might be made on the most appropriate approach to treatment considering the current state of the patient. Another issue affecting the implementation of ACPs are the paternalistic attitudes of the primary care providers and the family members of the patient, whereby, there is poor uptake of ACPs by choosing to prolong the life of a patient since death is regarded as a failure (Nee, 2013). This exposes patients to poor treatment processes that leads to a painful end (Reed & Shearer, 2011). The legal validity is also another reason for not implementing an ACP. This is due to the differences in the legislative laws governing the implementation of ACPs in the various states of Australia (Reed & Shearer, 2011). To solve the problems associated with the lack of implementation of ACPs in the health care facilities handling the old age with cancer, there is need to address the issue of communication and documentation (Lattime & Gattone, 2014). Establishing specific, clear and comprehensive ACD forms that can accurately capture the wishes of the patient can help achieve this. There should also be introduced electronic medical records to ensure the safety and easy retrieval of all ACPs in these facilities (Sulivan, 2012). When the information written on the ACP is not clear to the responsible caregivers, consultations should be made with the selected surrogate for clarifications to be made (Petersen, Parsell, Phillips, & White, 2014). For high-quality palliative care, the health care provider must get every detail as clear as possible. It is also very important for the improved training of health care providers in end-of-life care services. Politics has also been identified to have a strong influence on the implementation of ACPs in Australia. This is because of the differences in the laws and policies in the various states in Australia (SANE Australia, n.d.). The most appropriate solution towards this issue is for the federal government of Australia to formulate and implement standardised laws regarding the treatment of old age cancer patients in health care centres and in residential care centres in all states (Karabulut et al., 2015). The establishment of standardised laws that cut across all the various jurisdictions will increase the confidence of the primary care providers to implement the ACPs that were made in a different state. It will also support the implementation of ACPs in a coordinated and a systematic manner, hence, ensuring high-quality health care services to the old aged patients with cancer in Australia. A critique of why, where and when advance directives are applicable in clinical practice There is a great need to implement ACPs and ACD in contemporary clinical practice, especially among cancer patients in Australia. There is an increase in the number of aged population in Australia (Productivity Commission, 2013). The majority of the aged population are vulnerable to chronic diseases, for example, cancer. Therefore, an appropriate and effective method of treatment should be put in place to make sure that the old aged individuals who are suffering from cancer related diseases are well taken care of (Kleinpell, et al., 2014). This involves providing health care in a manner that values the dignity of the patient. Palliative care is one of the treatment methods that have been preferred by the family members of patients because it limits the cause of harm and possible pain that a patient may suffer towards the end-of-life (Johnson, 2012). This type of care is only achieved through the advance care planning using advance care directives. Besides promoting a dignified end-of-life to a patient, there are other reasons for applying the advance care directives in health care centres and residential care facilities. Advance care directives should be implemented in clinical practice environment because they encourage conversations regarding the things that are important to a patient towards the end of life, for example, a treatment that sustains life (Kalra, 2011). Secondly, it gives the patient a sense of control over his life especially towards the end by giving a patient the opportunity to map the preferred care. Thirdly, advance care directive help in engaging others in the process of decision making, for example, the family members, friends and primary care providers (Jayani & Hurria, 2012). This is important because a collective decision is more comprehensive than one that is made by one individual. According to Rhee et al. (2013), there is evidence showing an improvement in the patient’s psychological health, improved health care as well as improved decision making if advance care practice and advance care directives are implemented. These factors contribute towards an improved quality of the health care services offered to the patients (International Council of Nurses, 2012). Therefore, there are reduced instances of re-hospitalisation of patients, especially from the RACFs. Residential homes that are taking care of old aged patients should be encouraged to implement advance care planning and advance care directives. The RACFs play an important role in the taking care of the old-aged population in Australia. This is because the Australian aged population prefer to die in a home insread of dying in hospitals (Dalley & Woods, 2014). To maximise the benefits of ACP and ACD among cancer patients in the Australian clinical environment, some issues need to be solved. The government needs to provide efficient funding and necessary resources for the ACP programs in RACFs and hospitals. This involves funding activities like the education of health care providers responsible for caring for the old aged as well as funding the educative programs to create awareness on the topic. This is because the lack of awareness among people is the major reason for the low uptake of ACPs in Australia. The government should provide support to the healthcare professionals in their implementation of ACPs by putting in place a standardised policy for all Australian states. There have been efforts by Australian Health Ministers Advisory Council and the National ACP Working Party to standardise the ACP laws in the country. To make ACPs and ACDs more effective in the clinical environment in charge of old aged cancer patients, the implementation of these programs should be made in a flexible manner. Flexibility ensures that the type of care provided towards the end of life of a patient is responsive to the present conditions of the patient (Australia, 2013). In a healthcare setting, the required treatment for a patient may change due to the varying conditions of the patient. These changes may bring about the need for using other treatment methods on the patient. Therefore, the involved health care providers will be forced to use their judgment to provide the most appropriate and effective treatment plan for the patient. The new method may mean altering the treatment plan as directed in the ACP that was established by the patient and the family (Zamora & Clingerman, 2011). In such cases, the primary care providers should involve the selected surrogates in the making of such decisions. This is because the surrogates are the ones entrusted with implementing the best interests of the patient. Thus, they are believed to make decisions in such a manner that the patient would have. Their involvement also ensures that the wishes are not totally ignored by the care providers. This is in line with the Australian common law that aims at giving people the rights (autonomy) to control their lives (Fifield, 2014). Conclusion In conclusion advance care practice aims at ensuring a better end-of-life to all patients who are old aged and have lost their ability to make rational decisions. It involves the consultation and discussion between the patient, friends, family members and health care professionals, and the laying down of appropriate treatment methods, according to the wish of the patient. To establish this, legal documents referred to as advance care directives are used to put the methods into writings. There are numerous positive outcomes associated with the implementation of ACP and ACD in health care sector. To provide a dignified end-of-life, healthcare facilities taking care of old aged cancer patients are implementing ACP. Despite this, the uptake and implementation of ACP have been low in Australia. This is attributed to lack of awareness and willingness of people to embrace this practice. Differences in political laws across states are also another barrier to its implementation. These barriers can be eliminated by engaging in the widespread creation of awareness among the members of the public. 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