In this section
with children and families about death is one of the most difficult yet most
important things a paediatrician must do. It can arouse feelings of sadness,
guilt and fear; including the fear that we might cause further pain to families
who are already suffering. Like any difficult task, we often find ways to delay
these conversations, or avoid them altogether. But there is a downside to
avoiding this important conversation. It denies children and families the
opportunity to voice an opinion about the care they really want to receive and
where they want that care provided. This may mean they do not have the chance
to say and do things that are important to them.
Advance care planning is ‘a process of discussions between
families and health care providers about preferences for care, treatments and
goals in the context of the patient’s current and anticipated future health’
(Spicer et al. 2015). The objective is to determine the overall goal of medical
care, and the interventions that should and should not be provided. This will
guide current treatment, as well as future treatment in the event of a
deterioration in the child’s condition. In most cases these are
discussions that evolve and progress over time. This process of thinking ahead
is becoming increasingly important as technological advances see more children
survive with chronic and complex medical conditions.
This resource is intended to assist clinicians with
the difficult task of advance care planning. It contains three key elements.
is a companion document for the Victorian Government policy, Advance care
planning: have the conversation; A strategy for Victorian health services
discusses the ethical and practical aspects of advance care planning in the
paediatric setting and provides an approach to decision making.
framework provides a progressive approach to advance care planning discussions,
a series of suggested clinical triggers, illustrative case examples and
documents for capturing discussions and decisions.
guide is intended to help paediatricians and other clinicians approach advance
care planning by offering ways of framing the discussion and examples of
phrases that can be used.