Think Ahead is a public awareness initiative to guide members of the public in discussing and recording their preferences around end of life.
Think Ahead was developed by the Forum on End of Life in Ireland – an initiative of the Irish Hospice Foundation (IHF) – following a year-long public consultation process between 2009 and 2010 to explore what issues mattered most to Irish people around death, dying and bereavement. The Think Ahead project involves people thinking about and recording their preferences in the event of an emergency, serious illness or death, when they may be unable to speak for themselves.
Importantly, Think Ahead will engage all members of the public - young and old, those who are healthy and those living with illness. Ideally, this is something that we would do while healthy and then go on with living our lives, revisiting our preferences over the years to make sure that they continue to express our current wishes. In addition to enabling people to express their care preferences, the Think Ahead form will also allow people to record the location of key legal and financial documents and approve the donation of their organs and a hospital post-mortem in the event of their death. The Think Ahead form and useful related guidance and resources are available on the Think Ahead website.
Health care professions play a key role in this area. Nurses, in particular, are often involved in having advance care planning conversations with patients and their families. Think Ahead has been designed as a tool that can help with these discussions.
A pilot has been carried out which included four GP practices in Dublin and consisted of 100 patients up to 70 years of age. This has received very positive responses from the GPs and patients. Patients did not report being distressed at discussing these issues and indeed the vast majority of them welcomed being the opportunity to have this conversation.
I think often, as health care professionals, we can assume a reluctance on the part of the public to discuss these issues that may in fact reflect our own discomfort; experience with ‘Think Ahead’ strongly suggests otherwise. GPs, similarly, reported that being involved in the process of assisting their patient in filling in the Think Ahead form enhanced their relationship with the patient. GPs also saw the Think Ahead form as a means to avoid becoming involved in very difficult situations where a patient may have lost capacity and their loved ones have conflicting opinions as to what they would have wanted. In this way, the Think Ahead form gives relatives and partners peace of mind, knowing that they have done the right thing and have followed their loved one’s wishes.
For the next stage of developing Think Ahead, the focus will be on working with other health professionals across care settings. Two regional pilots were rolled out in Limerick and Louth from September to November 2012. The Limerick pilot was organised in conjunction with the Compassionate Communities project of Milford Care Centre, which is working with the community to engage people in conversation and action around death, dying, loss and care. People in Limerick and Louth were asked to think, talk and tell: to think about their wishes for end of life, talk to their families as well as other trusted professionals in their communities, including their doctors and nurses, and then to fill out their Think Ahead form and tell someone they trust where it is kept. Feedback from the pilots is currently being analysed. People have been specifically asked to fill out a survey which will allow the National Council of the Forum on End of Life in Ireland to learn about any features of the initiative and the Think Ahead form in particular that should be revised in advance of a national campaign.
Briefing sessions were held with health care professionals in Louth and Limerick, acknowledging the important role that they can play in facilitating these conversations. We are currently in the process of developing a guidance document for health care professionals in using Think Ahead as a care planning tool with their patients.
Finally, I would really encourage nurses to engage with this very timely initiative which empowers people to decide the care they would like for their future. I know I have filled in my own Think Ahead form and you might think of doing the same!
For more information on Think Ahead see www.thinkahead.ie or contact Sarah Murphy at 01 6793188.
Author: Ms. Una Marren, Deputy Director of Nursing at the Mater Misericordiae Hospital, Dublin. Una Marren is also a member of the National Council of the Forum on End of Life
