79 Legacy documents and advanced care planning

<h3></h3> Topic- Advanced care directives as legacy documents <h3>Discussion</h3> I work as a palliative care social worker and a narrative therapist. In my current work I’m interested in using a narrative therapy approach, which positions people as the experts of their own lives and believes that people make meaning from the stories they tell and re-tell. Story telling and legacy work helps patients and families to make of sense of death, dying and illness, on their own terms using their already existing knowledge about themselves. In South Australia, I often support people in completing an Advance Care Directive (ACD). Sometimes the ACD causes distress to patients and their families. I have seen that there are three major reasons for this. First, there are misunderstandings about the application of the document, second, the use of medicalised language, third, the document largely, in hospitals is used for pragmatic reasons. From a legal and medical perspective, it’s important for practitioners to understand individual’s wishes. In the community however the ACD is often used as a proxy legacy document by families. There is confusion on how these two perspectives ought be reconciled. I have been inspired by patients who want to resist the ACD document and its language. I have seen people take a very creative approach to the document as they record their end of life wishes, hopes, and dreams for loved ones, using humour, storytelling, and anecdotes. This is important, but none of it legally binding. Can we provide another way of documenting advanced care wishes AND legacy? How do we pay honour to legacy while we capture medical and legal information? <h3>Unique Contribution</h3> Over the years I have developed Narrative therapy questions I ask people that bring out this legacy, it often becomes a legacy document. I would like to speak about these questions. I am hoping to inspire the idea of a non-prescriptive legacy document intended to complement the existing ACD. This would be written by the patient alone or in combination with family. <h3>Implications</h3> Using narrative practices, we can privilege communities’ own knowledge, and expertise we can support folks to tell stories, make meaning, or legacy documents, that stand in contrast but also in parallel to medical directives.