Prioritising advance care planning in COVID-19 response

A blog post written by Linda Nolte, Program Director, Advance Care Planning Australia

As COVID-19 continues to destabilise our already stretched healthcare and aged care services, there is a strong case for prioritising advance care planning (ACP) as part of the COVID-19 response.

The Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) contains just one vague reference to ACP, lacking detail about how it should be coordinated. However if used appropriately, ethically and proactively, ACP offers an opportunity to help manage anticipated surges in healthcare demand and reduce the need for rationing during this ongoing health crisis.

Advance Care Planning Australia has recently launched a report, Advance care planning in Australia during the COVID-19 outbreak: Now more important than ever, recommending that more ACP conversations should be happening now with older Australians and those with chronic conditions. This may help to avoid scenarios where people who are hospitalised with coronavirus and prefer to avoid invasive treatment, are not unnecessarily ‘competing’ with people who would want it.

COVID-19 has shone a light on how poorly prepared some of our systems are in adapting to the pressures of this global pandemic. However it has also highlighted how unprepared we are as individuals to face this serious health crisis. As it currently stands 75% of older Australians do not have a plan to guide their treatment, should they become suddenly unwell, potentially leaving them without a voice or choice in how they are cared for.

As a cohort, older people are likely to have poorer outcomes if they become unwell from COVID-19, not to mention the ongoing risk they face of becoming seriously unwell due to illnesses of age such as cancer, dementia and heart disease.

While we would all agree that ACP should never be used as a blanket approach to deny treatment to groups in our society, it is also unacceptable to provide invasive treatment to a person who would refuse it if they could speak.

Advance care planning provides people with the opportunity to consider these scenarios and weigh their options, ideally with their doctor and loved ones, and make decisions ahead of time. Surely this would be preferable to leaving the burden of decision making to harried frontline healthcare workers and distressed family members.

In our report, ACPA has proposed 11 recommendations for health and aged care organisations and health practitioners to facilitate ACP as part of the COVID-19 response.

Our recommendations include:

• increasing health and aged care workforce competency in facilitating ACP using existing training resources
• ensuring systems are in place to store and access ACP documents, such as My Health Record
• making ACP conversations a routine part of care with GPs (in person or via telehealth).

We know that the health and aged care workforce are under immense pressure right now. We’re here to support them with ACP advice and free online learning and resources.

ACP information and resources
Information: advancecareplanning.org.au
Online learning: learning.advancecareplanning.org.au
Advice: Call 1300 208 582, Mon-Fri, 9am-5pm (AEST)

Linda Nolte, Program Director, Advance Care Planning Australia