Advance Care Planning

Advance Care Planning (ACP) helps you plan now for your future care needs, if you can't make or communicate your decisions in the future. It helps you express your values, beliefs, and life goals before you’re unable to.

ACPs should be prepared in conjunction with your GP. This can then be sent through to Grampians Health to keep with your medical record.

Grampians Health - Health Information Services

call 03 5320 4829 mail HISEnquiries@gh.org.au

What ACPs mean to general practice

GPs build ongoing, trusting relationships with their patients and are well-placed to initiate and promote ACP.

ACP means future decisions about your care is more likely to reflect your wishes. It identifies sensitive issues and clarifies the actions you would prefer in certain medical situations.

Having an ACP means others won't have to make decisions without knowing your feelings or wishes. It also reduces confusion and conflict about care decisions. With an ACP, you can feel reassured that there will be a common and calm approach to your end-of-life care.

GP's role in ACP

Include advance care planning as part of routine care during consultations or health assessments.
Assess the capacity of the patient/resident to appoint a representative and complete an advance care plan.
Support discussion and documentation of the advance care plan.
Apply the patient's/resident's wishes to medical care.
Review the plan regularly or when health status changes significantly.

Key points of an ACP

Starting the discussion is often the hardest but most important step.
Where possible, and consistent with the patient's wishes, involve family and any Substitute Decision Maker (SDM) in the discussion.
The opportunity to make an ACP should be part of routine care for all patients in residential aged care facilities.
To stay relevant, review ACPs regularly and with any change in health or residential status.
Communicating any ACP to all relevant healthcare providers is essential to ensure ongoing care matches the patient's wishes.

There are many resources available to assist General Practice with advance care planning.
(Adapted from Australian Family Physician 44/4 2015 pg:189)

Sharing an Advance Care Plan with Grampians Health

When you give permission for your advance care plan to be shared, it can be sent to:

Grampians Health – Health Information Services
Email: HISEnquiries@gh.org.au
Fax: 03 5320 4829

This can be submitted by your GP, or you can submit it yourself. The plan will be attached to your medical record. The document should be marked Advance Care Plan for filing in Alerts.

The minimum requirements are the patient's full name, date of birth, address, Grampians Health UR number (if known), and a contact number for the patient.

Grampians Health community-based services can offer information, support or education on the process around Advance Care Planning; however GPs are best placed to complete the documentation.