What is the Preferred Priorities of Care (PPC) document?
This page tells you about the Preferred Priorities for Care document. There is information about
The Preferred Priorities for Care is a document for you to write down what your wishes and preferences are during the last year or months of your life. It aims to help you and your carers plan your care when you are dying. This means that everyone involved in your care knows what you want and how you wish to be cared for. It is also called an advanced care plan.
The Preferred Priorities for Care plan was originally developed for people who had cancer and were living at home. It focused on where they wanted to be cared for when they were dying. Recently it was expanded to include other wishes and preferences that people might have when they are coming towards the end of their life.
Talking about these difficult issues is not easy for anyone. Thinking about what you want and talking about it with your doctor, nurse, family and friends means you can be realistic about what is possible. Planning ahead and deciding what you want can help you stay in control at a difficult time.
You decide what to include in the document. There are a number of questions to help prompt you, and your doctor, but these are very general. Most people need help and support from their doctor or nurse. They can help you decide what is possible and realistic for you. Any discussion usually includes thinking about
- How you feel about your cancer
- What you understand about your illness and what your outlook is
- Fears you may have, such as being in pain or being a burden to your family
- Particular needs that people caring for you may have
- Who you would like to care for you now and in the future
- Where you would like to die, such as at home, in a hospice or hospital
- What you do and don’t want to be told, for example how long you have to live
- Anything you’d like to do while there is still time, such as having a holiday
It is your choice whether you include some, all, or none of these issues.
The PPC is not a legal document but it is covered by the Mental Capacity Act (2005). So if you reach a point where you cannot make a decision about your care, what you have written in the document has to be taken into account.
If there are specific medical treatments you don’t want, you need a document called an advance decision to refuse treatment or a living will. You could use these documents to say that you don't want treatments such as being put on a breathing machine (ventilator). These documents are legally binding. There is more information about living wills in our dying with cancer section.
It is not easy thinking about dying, and about what you want during the time you have left. There is no right or wrong time to think about it. It is up to you.
For some people a diagnosis of cancer can make them think about their lives and what is important to them. Some people may start thinking about their wishes and preferences when they are diagnosed with cancer, even though the aim of their treatment is to cure it. Most people don’t start thinking about it unless they are told their cancer can’t be cured. Remember this doesn’t necessarily mean that you can’t have treatment, but the aim of that treatment changes. For example it may be that the aim is to slow down the growth of your cancer, control any symptoms you have, or both.
You don’t have to think about these issues and some people never want to. You may not want to fill in the PPC form straight away. There is no rush and you can take your time to think about it.
Usually your doctor or nurse tells you about the PPC document. But you don’t have to wait for them to start the conversation. You can ask them about it any time you want to. You may have already thought about it if you have come across a document called Planning for your future care – a guide. The guide has more information about what you might want to include in your PPC document.
It is important to review the PPC document regularly because people’s wishes can change. Changes need to be added to the document, along with your signature. You should also talk to your doctor or nurse so that they are aware of any changes you’ve made. They can help you tell anyone else who needs to know.
It can be difficult to talk to people close to you about the kind of care you want when you are dying. It is likely to be a very emotional conversation. Sometimes you may not agree. However it helps to involve your family and friends when you fill in the document, especially those likely to be involved in caring for you. It helps you all to be realistic about what is possible. It is a difficult time for everyone, but it can be easier if you are all clear about what each of you want and are able to cope with.
Once you have filled in the form your GP keeps a copy in your notes. They also send a copy to anyone else involved in your care, for example specialist nurses and doctors. A note is made on the front of your medical notes so that anyone caring for you knows you have a PPC.
You keep the form and should take it to any meeting to do with your health. Then you can make any changes and sign for them.
Deciding what you want and how you would like to be cared for is difficult especially if you don’t know what is available and possible. Talking to your doctors and nurses before you fill in the form will help you to be realistic.
Our dying with cancer section has more information about the different kinds of care available, making difficult decisions, and coping when you are dying. There is also information about talking about dying which can be very difficult and is something people often avoid. Reading this section may help you to feel more able to broach the subject.
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