The importance of Advance Care Planning
For over 40 years, nurse Diane Chaffers has been helping people live well and die well.
When she began her career in Australia in 1978, Diane quickly saw that there were situations that patients were going through that did not reflect what they wanted, such as medical interventions that they didn't understand.
There was no program in place to assist people with documenting their preferences and ensuring those were met, until 2002 when Respecting Patient Choices was founded at Austin Health.
The program aimed to provide Australians with best practice in advance care planning. That is, to help them plan for and record their future healthcare preferences in preparation for a time when they would not be able to express their choices around end-of-life decisions.
In 2010 Diane became a dedicated renal advance care planning clinician. Over the years, Diane has been there for many patients who chose to die with dignity.
As Diane describes it, a dignified death is one in which a person is allowed to go gently. Symptoms are managed. Family is present to accept and support their loved one, to reflect on and celebrate their life, and to say farewell.
Diane remembers one of her patients, a man in his eighties. He chose to stop dialysis and died shortly after, but not before he had a series of long conversations, a few lunches, and even a small party with his family.
"If you can bottle that experience," she says, "and show other people how it can be, if you're prepared to let go and if the family is prepared to let you go, it can be a very dignified experience."
Not everyone is open or ready to have end-of-life conversations. "They are not in touch with their own mortality," Diane says.
"They're simply not ready to face the fact that one day they will die. We don't talk about death as part of life."
Advance care planning is an ongoing process and acceptance of it has grown.
The number of dedicated advance care planning clinicians are increasing, there are more passionate advocates for advance care planning, and more doctors on board to have these important conversations.
However, public awareness is low.
To help increase awareness, Advance Care Planning Australia, a national program supported by funding from the Australian Government, is launching a campaign. National Advance Care Planning Week will take place 16-22 April 2018. Its goal is to encourage Australians to discuss their future health care preferences with their loved ones.
As Diane says goodbye to Austin Health for a sea-change in Portarlington, she hopes to see advance care planning reach everyone and become a normal part of conversations.
With upcoming changes to the Medical Treatment Planning and Decisions Act, all Austin Health clinicians are encouraged to join an information session.