P-112 What’s the plan in 2021?

Abstract

<h3>Background</h3> Treatment escalation plans (TEP) are increasingly used to document individualised advance care planning decisions in acute settings. A form initially co-designed by a multi-disciplinary working group at a tertiary referral UK cancer centre during the COVID-19 pandemic was later adapted based on clinician feedback and its utilisation re-analysed. <h3>Method</h3> A retrospective study was performed of TEP completion in adult non-elective admissions during April 2021. 100 notes were included in the final analysis (11 sets unavailable). Data gathered included patient demographics, capacity, diagnosis, disease information, prognosis and possible clinical interventions. <h3>Results</h3> Of the 100 patients, 45% had a TEP form (53.3% in 2020). 61% were for consideration of critical care and of those for ward-based care, appropriateness of interventions was fully completed for 76%. Clinicians were more likely to record information regarding anti-cancer treatment (89%), treatment intent (80%) and concurrent problems (87%) than prognosis (62%). Of those with a TEP, 53% were for resus. However, palliative care consultation was more common in those with a TEP form (58%) than those without (18%) and mortality was higher 13.3% (with TEP) vs 0% (without TEP). <h3>Conclusion</h3> TEP forms remain an important aspect of clinical documentation for all non-elective admissions to our tertiary referral cancer centre. However, there remains challenge in ensuring all patients have this completed during admission. Those patients with a TEP form are more likely to have palliative care consultation during their admission and therefore more likely to have advance care planning discussed.