Helping patients take control: hoping for the best, planning for the rest

Wednesday January 25, 2017

Patients will be encouraged to think through what they would and would not want if they should become unable to speak for themselves, in a new study funded by the ANZCA Research Foundation. 

“Advance care plans support the patient’s right to determine their own treatment pathway in the event that they can’t communicate their wishes themselves,” said lead investigator, anaesthetist Dr Debra Leung. “If patients become unwell and are unable to let health professionals know what they want, we rely on advance care plans to help us determine the most appropriate treatment for the patient.”

With such plans, the patient nominates a person they trust to make medical decisions on their behalf, discusses what values or principles they want the trusted person to apply, and then documents those wishes. 

“Advance care plans are important because people are living longer with complex medical conditions and having more surgery, particularly cancer surgery,” Dr Leung said. “If their surgery is high-risk, and they go on to develop complications, they need their wishes documented so that a treatment plan can be put in place that is in line with what they want.” 

Many patients who develop postoperative complications will have life-prolonging treatments that are sometimes distressing because their treating doctors do not know their wishes and goals of treatment.  

The trial will be conducted at the Peter MacCallum Cancer Centre in Melbourne and will involve anaesthetists raising the issue of advance care planning with 100 patients at pre-surgery consultations. “We know that patients would benefit from having these discussions, but currently no one’s doing it; one reason is because doctors feel uncomfortable, fearing that patients will get distressed and overwhelmed. Some doctors don’t want to raise it in case it persuades the patient against needed surgery.

“But the point isn’t necessarily to talk them out of the surgery but to help them plan for the eventuality that something bad might happen down the track after surgery. We need to hope for the best and plan for the worst.”

Dr Leung said every patient will have a different “line in the sand”: “One patient will say, ‘As long as I can sit there and see my grandchildren playing, even if I am dependent, that’s enough for me.’ But for other people, their independence is paramount: ‘If I can’t dress and wash and feed myself then I don’t want life-prolonging treatment.’”

Patients will be divided into three groups at their pre-surgical consultation: one will have a standard pre-surgical consultation, one will be given information about advance care plans, and the third group will be offered a detailed risk discussion about their surgery.  “At the end, we will look at whether these different types of discussions increase a patient’s readiness to talk about, and to actually do, an advance care plan. Anaesthetists meet people at a time when they are at a crossroads in their care, and we need to make the most of that opportune moment.”
Find out more about the ANZCA Research Foundation and the 2017 research grants.

For more information or to request interviews, please contact ANZCA Media Manager Karen Kissane on +61 408 259 369, +61 38517 5303, or email communications@anzca.edu.au.

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