Find out about the Preferred Priorities of Care (PPC) document.
What is it?
The Preferred Priorities for Care (PPC) is a document for you to write down what your wishes and preferences are during the last year or months of your life. This document is used by some hospitals in England and Wales. Other hospitals have developed their own form for this purpose.
The PPC 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.
This 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.
Information in the document
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
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.
Who to talk to about the PPC
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 might 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 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.
Some people might start thinking about their wishes and preferences when they are first diagnosed with cancer, But this is not the case for everyone. You might not want to fill in the PPC form straight away. You can take your time to think about it.
When the PPC is filled in
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. It’s helpful to take it to any meeting to do with your health.
People’s wishes can change. So if you want to change or add anything to the document, you can. Make sure you add your signature to these changes.
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.
More information about dying with cancer
You can read about the different kinds of care available, making difficult decisions, and coping when you are dying. Also, find information about talking about dying, including supporting children.