Volume 200 - Issue 10
Difficult but necessary conversations - the case for advance care planning
Author: Liz Marles
Med J Aust 2014; 200 (10): 578. || doi: 10.5694/mja13.00108
Published online: 2 June 2014
Published online: 2 June 2014
GPs are best placed to begin discussions about end-of-life care, and being well prepared is important
To the Editor: The Royal Australian College of General Practitioners (RACGP) noted with interest the two articles published in the Medical Journal of Australia1 and MJA InSight2 that promoted advance care planning (ACP) and end-of-life care discussions as an important element of everyday clinical practice for Australia's GPs.
The RACGP is an advocate for ACP and end-of-life care discussions at a primary health care level. It is in general practice that ongoing and trusted patient relationships are developed, placing GPs in an optimal position to initiate and promote ACP. Awareness and acceptance of ACP has grown considerably over the past decade as evidence in support of its benefits has continued to emerge.3-5 As medicine has expanded from offering “cure” to include the management of chronic and incurable conditions, the importance and prevalence of ACP have increased.
In recognising the important role that Australia's GPs play in the promotion and delivery of ACP, the RACGP developed a position statement in 2012 encouraging the integration of ACP into routine practice. The RACGP continues to draw on and promote this position in its discussions with government, thought leaders and the general practice profession at large.
The RACGP concurs with the challenges detailed in the MJA article and is committed to providing its members with the knowledge and skills required to have these sensitive and sometimes difficult conversations. The RACGP has launched an online education module via gplearning to assist GPs in further developing skills in the delivery of ACP and end-of-life care discussions.
The RACGP will remain an advocate for the incorporation of ACP and end-of-life conversations into routine general practice and is committed to providing Australian GPs with the education and skills necessary for confidently and appropriately managing these conversations and patient's concerns.
Competing interests
No relevant disclosures.
References
- Scott IA, Mitchell GK, Reymond EJ, Daly MP. Difficult but necessary conversations – the case for advance care planning. Med J Aust 2013; 199: 662-666. 1
- MacKee N. Make advance care plans routine. MJA InSight [internet] 2014; 18 Nov. 2
- Silveira MJ, Kim SYH, Langa KM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med 2010; 362: 1211-1218. 3
- Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ 2010; 340: c1345. doi: 10.1136/bmj.c1345. lefthere
- The Clinical, Technical and Ethical Principal Committee of the Australian Health Ministers' Advisory Council. A national framework for advance care directives. Consultation companion guide for the draft framework. Draft ed. Canberra: AHMAC, 2010. 5