O10.2 Advanced Care Plans

General practitioners could begin the discussion with patients about the course of their disease. Consideration should be given to appointing an Enduring Power of Attorney (EPOA) for financial matters, as well as an EPOA for medical management. There are multiple online resources, e.g. from the Office of the Public Advocate in Victoria: http://www.publicadvocate.vic.gov.au/,  but these are also available through any solicitor or legal service and may vary between States and Territories of Australia. Over time, physicians may need to introduce topics of choices regarding intubation, admission (or not) to ICU and patients’ views on “not for resuscitation” or medical treatment orders. This may involve a discussion regarding quality of life and choices they may wish to consider.

Issue for discussion could include Advanced Health Care Directives. It is crucially important that next of kin, medical carers and their family solicitors are aware of the existence of these legal documents. They are of course useless residing in a drawer at the patient’s home unknown to those who can enact their directives. The discussion about pros and cons of intubation and easy vs. difficult weaning from intubation (including the concept of tracheostomy) may need input from a respiratory physician, but it is ultimately up to the patient’s general practitioner to begin the discussion and not leave it too late in the patient’s disease course.

A useful resource to guide patients in making these choices is www.respectingpatientchoices.org.au/