July 2004

Program helps patients make care choices

Austin Health is training staff to talk to patients about documenting their wishes for treatment options and end-of-life care.

The Respecting Patient Choices (RPC) training program has been so successful Austin Health has attracted State and Federal Government funding to extend it to other health-care facilities nationally.

Since the start of the RPC pilot study in 2002, 95 per cent of the major wishes were fulfilled for the many patients who had their choices documented.

Cardiologist Dr Jennifer Johns trained as a RPC consultant and often speaks to her patients about advance care planning and end-of-life choices.

‘We want to be positive but we still need to talk to patients about the possibility of cardiac arrest and brain damage if they occur down the track,’ said Dr Johns.

‘The RPC course trains consultants to draw discussions into general views about death and dying and how people want to be cared for in their final stages,’ said Dr Johns.

‘Patients are encouraged to document their wishes and detailed notes are taken after discussion with the patient and their family.’

The signed advance care plan is kept in front of the patient’s history and patients can change their choices about receiving or declining specific treatment at any stage that they are still able to communicate.

Dr Johns was in the very first two-day course for RPC consultants.

‘The trainees were all different ages from different areas–nursing, allied health and medicine.

‘It was rewarding because the role-playing exercises helped us experience our patients’ perspectives and also helped us discuss these difficult issues with our own family,’ she said.

Dr Johns said that advance care planning was something people needed to look at as a community, not just as a hospital or just as doctors.

‘I had this discussion with my 14 year-old son.

‘He strongly objected to having to be kept alive on a ventilator,’ she said.

Dr Johns said some patients wanted everything possible done, even if that meant being kept alive on a machine.

‘It’s their choice and, of course, their wishes would be respected.

‘That is what it’s all about—respecting patient choices,’ said Dr Johns.

Austin Health Respiratory Unit division-two nurse Carmel Keenan trained as a RPC consultant.

‘The RPC course was what I was looking for,’ said Ms Keenan.

‘I had patients who deeply objected to the onslaught of injections and treatments that were only prolonging their agony.

‘It is important to take the time to sit down with both the patient and family, to make sure they understand the concept of respecting their choices of care, in case they are no longer able to communicate towards the end of their life.’

Ms Keenan said advance care planning could apply to situations as simple as oxygen supply—relief if the patient was distressed but refraining from connection to a breathing machine.

‘You realise that the RPC is best practice for end-of-life care when a family says thank you for keeping every promise their loved-one wanted,’ said Ms Keenan.

• For more information on Respecting Patient Choices (RPC) training contact program manager Liz Stickland on 9496 5660.