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Advance Care Planning

Advance Care Plan (ACP) is the process of planning for future health and personal care whereby a person’s values, beliefs and preferences are made known so they can guide clinical decision-making at a future time when the person cannot make or communicate their decisions due to lack of capacity. The ACP mainly consists of:

a. appointment of a substitute decision maker (when the person loses decision making capacity);
b. written record of the person’s preferences or instructions for future health care and end of life; and/or
c. written Advance Care Directive and/or Refusal of Treatment Certificate.

Documents and Tools for Clients and Carers

Take control: a guide to making enduring powers of attorney

This free booklet is produced by Office of the Public Advocate, and provides the information and forms you need to appoint a medical treatment decision maker, complete an advance care directive or make an enduring power of attorney.

It explains the difference between a medical support person and a medical treatment decision maker.

The information and forms in this edition have been updated to take into account the implementation of the Medical Treatment Planning and Decisions Act 2016 which came into effect on 12 March 2018.

Click here to download the Take control: a guide to making enduring powers of attorney booklet

Dying to Talk Discussion Starter

Dying to Talk encourages Australians of all ages and levels of health to talk about dying.

Despite being something that touches everyone, death doesn’t receive enough visibility. Dying to Talk aims to reach into the community to normalise dying in Australia and to help Australians work out what’s right for them at the end of their lives.

Having a conversation with your loved ones about your end of life wishes will help them to make decisions on your behalf should you be unable to communicate your wishes. The Dying to Talk Discussion Starter guides you through talking with your loved ones.

Click here to view the Discussion Starter booklet.

Safeguarding the end of the rainbow (a guideline for LGBTI community members)

COTA Victoria and Transgender Victoria (TGV) have produced a resource tailored to the needs and concerns of LGBTI community members in relation to planning for future care and medical needs, financial and estate planning, and funeral and burial wishes.

Click here to view the Safeguarding the end of the rainbow booklet.

Documents and Tools for Health Professionals

When your adult patient cannot consent

Do you know what to do when faced with a patient who does not have the capacity to consent to (or refuse) medical treatment?

The Medical Treatment Planning and Decisions Act 2016, which came into effect in March, outlines the steps all registered health practitioners need to take when treating a patient, in Victoria, who does not have the capacity to consent to, or refuse, medical treatment.

The Office of the Public Advocate has developed a range of resources including an app, fact sheets, a flow chart and video presentation to help health practitioners understand this new legislation and their responsibilities.

The App

  • Takes you through the steps you need to take if a patient is unable to consent to medical treatment.
  • Includes links to important definitions, additional information and online forms.

Helps you identify if you need to  request the Public Advocate to make a medical treatment decision.

Click here to download on iTunes

Click here to download on Google Play

The Video

This 45 minute presentation by OPA’s Senior Medical Treatment Decision Maker provides an overview of the new legislation and the steps you now need to take if a patient is unable to consent to medical treatment.

Click here to view the video on youtube

The Flow Chart

This two-sided poster is designed to be printed out on A3 paper. It includes key information, as well as a handy flowchart.

Click here to download the flowchart

Fact sheets for Health practitioners

Care Plan for the Dying Person

The Care Plan for the Dying Person – Victoria was developed by the Victorian End-of-Life Care Coordinating Program (VEC) and has been endorsed by The International Collaborative for Best Care for the Dying Person.

The Care Plan aims to ensure that a dying person and those identified as important to them experience a coordinated person-centred approach to care regardless of their diagnosis or healthcare setting. The Care Plan supports a model of care that combines frequent assessments, critical thinking, individualised care planning, shared decision-making and continuous review to ensure the focus of care is on the dying person and those close to them. It is informed by an evidence-based framework that supports care delivery in the last days of life, compliant with Australian** and International*** Quality Standards

Click here to view the Care Plan for the Dying Person

Click here to view the Health Professional USER GUIDE

Click here to view the Family Member and Friends Information Brochure

CPG Advance Care Planning Guidelines

The purpose of advance care planning guidelines is to support clinical staff to “have the conversation” with clients and caregivers about end of life decision making, engage clients and their families in decisions about their care and help them to undertake advance care planning.

Click here to view the CPG Advance Care Planning Guidelines.

Medical Treatment Planning & Decision Act 2016 - Clinical Complication

This powerpoint presentation by Dr Barbara Hayes FAChPM, Clinical Lead – Advance Care Planning, Northern Health, was presented to Health Professionals at the Advance Care Planning Seminar at West Gippsland Healthcare Group in November 2018.

Click here to view the powerpoint presentation.

Useful Websites

ACP Talk

ACP Talk has been designed in collaboration with Australian religious and cultural leaders and organisations. It is intended to provide informational support for health professionals conducting advance care planning with people from different religious and cultural backgrounds.

Click here to be directed to the ACP Talk website.

Advance Care Planning Australia – BE OPEN, BE READY, BE HEARD

Advance Care Planning Australia is a national program that encourages people to consider their values, beliefs and current and future health care goals.

The learning program delivers a range of online courses, face-to-face workshops and webinars for all those interested in learning more about advance care planning.

Designed for health professionals, care workers and the general public, our range of educational programs offers everything from an introduction to advance care planning to more specialised courses for health professionals.

Click here to be directed to the Advance Care Planning Australia website.

Austin Health – Advance Care Planning

The Advance Care Planning (ACP) Department within Austin Health delivers patient services, education and training across the organisation and externally. Since 2002 Austin Health has worked extensively with other health services to provide training and foster innovation in the field. With the support of the Commonwealth Department of Health it also manages “Advance Care Planning Australia” initiatives to support national collaboration and a national resource library.

Click here to be directed to the Austin health – Advance Care Planning webpage.

The GroundSwell Project

The GroundSwell Project is a not for profit organisation known for using innovative arts and health programs to create social and cultural change about death and dying.

Their aim is to promote resilience and wellbeing in response to end of life issues and to encourage people to build their death literacy.

Click here to be directed to the GroundSwell Project website.

Office of the Public Advocate (OPA) – Power of attorney

Powers of attorney are legal documents that let someone appoint another person who can make decisions for them or support them to make and give effect to their own decisions. Powers of attorney give choice and control. The Office of the Public Advocate (OPA) website provides readers with all the information required to appoint a; power of attorney and substitute decisions makers.

Click here to be directed to the Office of the Public Advocate (OPA) – Power of attorney webpage.

Disclaimer: GRPCC provides these links for information purpose only and is not responsible for the content of these websites. If you notice any of the links are broken, or would like to suggest additional information resources to be added, please contact us.


Conversations – Creating Choice in End of Life Care

Conversations – Creating Choice in End of Life Care, presents eight simple, cost effective recommendations to transform End of Life Care in Australia by creating choice through conversations.

Click here to view Conversations – Creating Choice in End of Life Care