Reassessing advance care planning in the light of covid-19BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1927 (Published 18 May 2020) Cite this as: BMJ 2020;369:m1927
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I believe everyone should be offered advance care planning upon reaching a certain age or level of frailty. I agree with Hopkins and colleagues who have highlighted an important issue that has been emphasised during the covid-19 pandemic, whereby care planning needs to be unique and personal for each patient, incorporating their thoughts and concerns, whilst ensuring they receive appropriate medical treatment(1).
A tick box exercise cannot take the place of a compassionate collaborative conversation with a patient, however I argue that it does have a role. Following in the footsteps of the aviation industry, a World Health Organisation (WHO) safety checklist has been adopted in surgery to ensure that patient care in theatre minimises risks by ensuring the surgical team are fully informed of the procedure. The process of advanced care planning can be adapted to incorporate this model.
An advance care planning checklist would standardise the process to ensure that every patient receives equal options for their future care. For example, offering this to patients aged over 75 in the community via a GP setting, and to hospital admissions scoring a 6 or above on the clinical frailty scale would hopefully cast a net wide enough to ensure that all patients had enough time to think about and make decisions for their future.
It is imperative that this does not become a tick box exercise, but an aid for the clinician to steer the conversation to explore ceilings of care. Open conversations with the patient are essential to form the basis of advance care planning to ensure they are able to voice their concerns and priorities, with minimum confusion and distress. The plan could be tailored to an individual’s circumstances to match their range of comorbidities, level of frailty and general health, to ensure their wishes are met at every stage.
Conversely the option to not make advanced decisions should also be a possibility. Some patients may not want to think about the prospect of death and making plans surrounding this may have a negative impact on their mental health.
Ultimately, advance care planning, or rather the option to discuss future care, needs to become standard practice where patients expect these discussions rather than feeling singled out due to their health. It should embody patient centred choices, aided and supported by their loved ones, along with guidance from clinicians in order to decide which path is best for them.
1. Hopkins SA, Lovick R, Polak L, Bowers B, Morgan T, Kelly MP, et al. Reassessing advance care planning in the light of covid-19. BMJ [Internet]. 2020 May 18 [cited 2020 May 19];369:m1927. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.m1927
Competing interests: No competing interests