Planning ahead: end-of-life care, treatment escalation and advance care planning

Dr Adam Hurlow, Dr Jonathan Hurlow, Dr Alice Pullinger and Dr Wendy Neil

60 minutes


August 2022

Learning module

CPD domain:
Clinical, Professional


We all plan ahead. We book holidays, we save for weddings and we invest in university education in anticipation of future careers. We do so without being certain any of those events will transpire as hoped.

When the public and professionals are asked about what makes a good death the key components include: clear decision-making, the opportunity to plan ahead and being involved in discussions.

Despite this, large numbers of people at risk of foreseeable life-threatening illness are not given the opportunity to consider and agree to recommendations about future care and treatment should they be unable to participate in decision-making at the time.

Planning ahead, including advance care and treatment escalation planning, increases the likelihood that care and treatment is consistent with the individual's preferences and minimises invasive treatment of limited clinical benefit.

All professionals involved in care should be equipped to support patients, and the people important to them, to understand how their health is likely to change, weigh up the burdens and outcomes of treatment and make realistic, informed recommendations to guide future care.

Within psychiatry, we face additional challenges when addressing these emotive and complex concepts. Special consideration should be given to unpicking suicidal depressive phenomena from informed decision-making, or overcoming other difficulties such as the challenges in understanding that are experienced by people with an intellectual disability, recall challenges linked to cognitive impairment, interference in decision-making from symptoms of psychosis, or the complex challenges of impairments in weighing things up for people with a personality disorder.


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