Quality Standards for Diabetes Care Toolkit

Advanced care planning

The focus of advanced care planning or end-of-life care can be viewed from two perspectives: those of the individual and family/whānau planning for end-of-life care and health care professionals involved in end-of-life care for an individual. Resources for individuals about advanced care planning are included in the resource section.
The International Diabetes Federation provides a rationale and evidence base for the care of individuals at the end of their life. Individuals at the end of life are characterised by a significant medical illness or malignancy and have a life expectancy reduced to less than one year. Recommendations reflect compromised self-care (fatigue, drowsiness from medicines), the need for pain relief, avoiding dehydration, withdrawal of treatment, and a raised threshold for investigation. Goals of care are often very different from other categories. These individuals typically require significant health care input and specific diabetes care may not necessarily be the most important priority. However, diabetes care remains important to manage symptoms, comfort, and quality of life (International Diabetes Federation 2013).
There does not appear to be one overarching guideline regarding advanced care planning pertaining specifically to diabetes for New Zealand. However, a number of different sources specific to New Zealand are available around end-of-life or advanced care planning and include:

Best Practice Advocacy Centre (BPAC) NZ (2006) Providing Palliative Care to Māori available at: www.bpac.org.nz/resources/campaign/palliative/palliative_Maori.asp

BPAC NZ (2011) Treatment for the dying patient: The Liverpool Care Pathway available at: www.bpac.org.nz/BPJ/2011/june/lcp.aspx

BPAC NZ (2011) End-of-life care for patients with chronic disease: The need for a paradigm shift available from: www.bpac.org.nz/BPJ/2011/november/end-of-life.aspx

Hospice NZ Standards for Palliative Care (2012). The purpose of this document is to ensure the best possible care for all people in New Zealand as they approach the end of their life and die. Available here: www.southerncancernetwork.org.nz/file/fileid/45559.