Background Advance Care Planning is an integral part of The Gold Standards Framework (GSF) Training Programmes in end-of-life care in the UK, in a variety of settings. GSF enables a systematic way to identify, assess and plan care for patients, to deliver improvements in end-of-life care- right care, right place, right time etc. Much progress has been made but there is more to do to mainstream ACP nationally.
Aim The aims of ACP use within GSF Programmes, are:
To offer ACP discussions to every appropriate person.
To offer advance statements to all, refusals of treatment (ADRTS) to those requiring them.
Most ACP discussions are with the appropriate person for ongoing support ie GP, care homes staff.
ACPs provide an action plan for care and a measurement of quality provision.
Methods Evaluation following GSF training and Accreditation in five settings are described, illustrated with quantitative and qualitative examples. ACP forms a key part of GSF Accreditation with the GSF Quality Hallmark Award.
Results Increased uptake of ACP discussions was enabled in all settings, e.g. 95% in care homes, 75% primary care, contributing to reduced hospitalisation.
Discussion Use of GSF training to increase staff confidence, competence and organisation of care across many settings enables more ACP discussions, leading to better quality end-of-life care and fewer hospital deaths.
Conclusion It is possible to systematically disseminate ACP as part of a comprehensive programme to improve end-of-life care across many settings, though more work is needed to mainstream nationally.
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