Download the full guideline here

1. Executive Summary

Advance care planning (including end of life discussions, advance statements and advance decisions to refuse treatment) are being promoted as part of the NHS end of life care strategy. Such discussions require great skill and considerable knowledge if they are to provide patients with real choices. Older people, especially those with cognitive impairment, are particularly vulnerable in this context.

The BGS, in conjunction with the RCP and other stakeholder groups, have prepared evidence based guidelines on advance care planning with special reference to older people. The key recommendations are that discussions should be led sensitively, being aware that many people do not wish to have such discussions thrust upon them, and that the professional leading the discussion has the appropriate knowledge and training to advise the older person. The full guideline can be found at here

One specific area of controversy related to advance care planning is the use of advance decisions to refuse treatment (ADRTs). Although these decisions will only be used in a minority of people (no more than 10%), they can cause considerable uncertainty for health professionals faced with patients who have lost capacity but have prepared a draft statement. Some of the issues are discussed in the guidelines above, but more details on ADRTs can be found at www.adrt.nhs.uk

  
Dr S Conroy for BGS Policy Committee

Review date: February 2012