see also: [[palliative care]] see: [ACEM policy on End of Life and Palliative care in the ED](x-devonthink-item://BC6A9512-B7E7-4659-ACDC-94ED842227E9), [PREDICT study 2015](bear://x-callback-url/open-note?id=4D0978DF-8A67-4E0C-855B-FE9ED58AD5B5-8891-0000055A238CC12A) > Advance care planning is a process enabling a patient to express preferences about his or her future health care in consultation with their health care providers, family members and other important people in their lives. It is based on the ethical principle of respect for *patient autonomy*. **Benefits** - can reduce rates of non-beneficial care and hospitalisation - allows patients' choice to remain and be cared for in their preferred location when they are unable to fully communicate their wishes - allows patients' wishes to be respected and dignity preserved in the event of a medical crisis - reduced stress on families and on medical staff - Communicate who they have appointed to be their Medical Treatment Decision Maker or Person Responsible. *non-beneficial treatment*: Interventions that will not be effective in treating a patient’s medical condition or improving their quality of life e.g. diagnostic tests, medications, artificial hydration and nutrition, intensive care, and medical or surgical procedures. ## Patients who may benefit from Acute Resuscitation Plan **CriSTAL** (Criteria for screening and Triaging to Appropriate aLternative care) screening tool - Age > 65 AND EWS > 4 AND other risk factors for short/medium term death - advanced malignancy, CKD, CHF, COPD, new CVA, MI, mod/severe liver disease - cognitive impairment - hospitalisation within the last year - repeat ICU admissions - [[Elder abuse#Frailty]] score mod/high - RACF resident - proteinuria - abnormal ECG **SPICT:** - general indicators of deteriorating health - poor performance status or deteriorating, with limited reversibility (eg need health with personal care, bed/chair for >50% of day) - ≥ 2 unplanned hospital admissions in 6 months - weight loss 5-10% over past 3-5 months or BMI <20 - persistent symptoms despite optimal treatment of underlying conditions - lives in nursing home or needs care to remain at home - pt requests supportive and palliative care or treatment withdrawal - any clinical indicators of advanced conditions - cancer, dementia/frailty, neurological disease, cardiac/valvular disease, resp disease, renal disease, liver disease ## past questions: - [ACEM 2022 - Q4 Advanced care directive](x-devonthink-item://73E173B3-A627-4FEE-9149-36CBFF528DB0?page=9) - [AFEM 2023.2 - Q15](x-devonthink-item://E50B2E75-61B9-43CD-9559-D5EBB0B3E220?page=24) - [ACEM 2022 OSCE 2024](x-devonthink-item://B75FA5DE-513B-4891-8283-60658C492DF5)