Proactive Enhanced Advance Care Plan (PEACE)

Information for patients, families and carers
The aim of this information leaflet is to answer some common questions about the PEACE plan. If you have further questions or concerns after reading this leaflet, please speak to a healthcare professional looking after you.

What is a Proactive Enhanced Advance Care Plan?
A proactive enhanced advance care (PEACE) plan is a non-mandatory document to help health care professionals deliver the best care to people with life limiting illnesses who are in their last phase of life. It can be completed at home, in a care home, a hospice, any hospital setting, or wherever you may be.

Background
The PEACE document was first developed at Kings College Hospital, London. Research showed that many people were being admitted to hospital in the last few days of life rather than remaining in the comfort of their own homes. By discussing with the person and/or their representative, where they would like to be cared for at the very end of life, the PEACE plan has increased the number of people who spend their last days in their preferred place.

What do I need to do?
The PEACE plan is completed following discussions between you, those important to you, and your healthcare professionals. A paper copy of the plan will be provided and you may wish to keep this in a safe place that your family / carers are aware of. It is recommended that the PEACE plan is regularly reviewed by yourself and the healthcare team and amended as agreed. It can be withdrawn at any time.

What happens if a person does not have capacity to make decisions?
The healthcare professional will complete a Mental Capacity Assessment (MCA) and will discuss this with the individual’s nominated representative.

How will the PEACE plan help?
Your PEACE plan provides information about you to help identify your needs and how they can be met when your condition changes. It will help you to access healthcare that best suits you, within a setting you are familiar with and reduce the need for unnecessary hospital visits. Discussions may cover topics such as feeding, infections, and whether hospital admission might be of benefit or potentially a disadvantage to you. The plan therefore enables health care professionals, looking after you, to plan and deliver your future healthcare.

Who will my PEACE plan be shared with?
Your PEACE plan will be shared with those important to you, your GP, as well as the relevant community and hospital staff. Any changes that you and your healthcare team make to the plan will be updated in the relevant care record and shared with the appropriate care staff.

What does this mean when I become unwell?
The PEACE plan can provide an invaluable source of information and reassurance for you, your family and people close to you. For some people who are in the last stages of their life, a medical review by the GP, or even admission to hospital may be beneficial to your health and wellbeing. The PEACE document can help record when this may be the case. However, for many people approaching the last weeks or months of life, admission to hospital can be a distressing event with no added clinical benefit. The PEACE plan can indicate how best to deliver care in your own home or care setting, and what support is available.

What care will I get in the last days of life?
In the last days and weeks of life, the GP or Specialist Nurse may suggest ‘just in case medications’ which can be given to relieve symptoms such as pain, distress or nausea. A comprehensive assessment at this time will support any other care needs that may be required to ensure your comfort and wellbeing.

What about Cardiopulmonary Resuscitation (CPR)?
As part of the PEACE plan, a discussion about CPR will usually take place. You and/or your representative’s views will be listened to. Often people have already decided against CPR, because of fears of being ‘brought back’ with a poorer quality of life. For most people with a life-limiting illness approaching the end of their life, CPR will not be successful. In this situation, a ‘Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)’ decision, will put in place. This allows death to occur without futile medical intervention or unnecessary transfer to hospital.

Is the PEACE plan a legally binding document?
No, the PEACE plan is an advisory document only. The plan will support you and guide healthcare professionals, who you may or may not be familiar with, to meet your individual needs.

Can I change my mind?
Yes, at any time. The PEACE plan acts as a guide to the provision of treatment and can be updated in response to changes in your clinical condition.

Who writes the plan?
The plan is written by a multi-disciplinary team of healthcare professionals looking after your care. You and your representatives are involved in discussions as much as possible to ensure your plan is in line with your wishes. This can be updated at any time.

If there is an Advance Directive we can use this to help the healthcare professional write the plan. If you have nominated a Lasting Power of Attorney for Health then they will also be consulted. An Independent Mental Capacity Advocate (IMCA) may be consulted in certain circumstances.

Contacts / further information
Please do not hesitate to contact your healthcare professional, provided in the box below, to discuss any of the content of this information leaflet. He/she will be happy to support any questions you have at any time. The information is for guidance purposes only and is not provided to replace any professional clinical advice from a qualified health professional.

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