57 Who would know? Embedding future care planning for all patients approaching the end of their lives

Abstract

Background Future Care Planning (FCP) empowers individuals to receive the care and treatment they choose towards the End of Life (EoL). Developing personal Advance Care Plans (ACPs) and Anticipatory Clinical Management Plans (ACMPs) improves patient and family satisfaction and reduces ‘burdensome’ treatments yet is not universally offered. An evaluation of current FCP across a locality was undertaken to establish current practice, explore barriers to implementation and guide future work. Methods Case note review of patients known to specialist palliative care services(SPCS) for evidence of FCP and information–sharing between organisations (n=52) Review of ACMP content and information–sharing between organisations (n=50) Health–care professional survey of knowledge, experience and expectations of FCP (n=39) Results Preferred Place of Care was documented for 85% of patients known to SPCS, but there was limited documented evidence of other forms of FCP (uDNACPR:38%, ACMP:2%, ADRT/LPA:0). FCP undertaken by SPCS was rarely available in hospital records. The number of ACMPs is increasing (49 (2017/18) c.f. 198 (2018/19)), predominantly for care home residents, with 60% developed by newly appointed frailty practitioners. They consistently included key EoL topics but only 38% were available within hospital records. Staff had limited knowledge and experience of FCP, and the processes for recording and sharing patients wishes. They felt more training and more time would enable them to facilitate more ACP conversations Conclusions Not all patients are currently offered an ACP conversation. Although information packs are available further promotion is required to ensure they are given. There is a need to continue current network-wide ACP training; additional targeted support for those in key roles has been introduced. Collaborative working between SPCS, frailty, acute and primary care teams is ongoing to ensure a consistent approach, and shared documentation and processes to ensure patients wishes are respected as they move between care settings.