71 ‘Is this a conversation about death?’ planning for future care with patients with advanced cancer: examining the feasibility of using the trajectory touchpoint technique for advance care planning. A qualitative study

Abstract

Background Advance Care Planning (ACP) enables people to make plans regarding their future healthcare and has been shown to positively impact on the quality of patient care. There are multiple barriers to engaging in the process of advance care planning. These include a lack of understanding of what ACP entails and patient, relative and healthcare professionals’ anxieties in discussing potentially distressing issues. The Trajectory Touchpoint Technique (TTT) was applied to ACP discussions in order to create a visual aid to help circumvent these barriers, allowing deep and detailed discussions of potentially distressing topics. Methods A literature review was performed to identify topics that patients may have wanted to talk about. These were ratified through a human centred design process (Design Thinking) with members of the public. ACP discussions were performed using the visual aid on an in-patient specialist palliative care unit. Qualitative enquiry was used in the form of patient, relative and clinician interviews following ACP discussions to evaluate the feasibility and benefits of using the visual aid. Results Data was collected over a 4 week period in a single acute in-patient palliative care unit. Patients (n=4), relatives (n=2), and clinicians (n=3) participated in the study. Thematic analysis of interview transcripts showed the visual aid enabled patients to begin the conversation by talking about the ACP related issues they felt comfortable with and that were most important to them. Relatives found the visual aid helped to identify what issues can be discussed. Clinicians found the visual aid helped focus the ACP discussions. Conclusions We have demonstrated that the visual aid was useful in facilitating ACP discussions with this cohort of patients, relatives and clinicians. Further, we suggest these findings warrant trials across primary and secondary care for patients in end-of-life to further develop this approach to ACP facilitation.