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P-31 The impact of advance care planning on place of death during the COVID-19 pandemic: an analysis of data from coordinate my care, a large electronic palliative care coordination system
  1. Philippa McFarlane,
  2. Catey Bunce,
  3. Katherine E Sleeman,
  4. Martina Orlovic,
  5. John Rosling,
  6. Alastair Bearne,
  7. Margaret Powell,
  8. Julia Riley,
  9. Jonathan Koffman and
  10. Joanne Droney
  1. The Royal Marsden NHS Foundation Trust, London; Cicely Saunders Institute, King’s College London


Background Anticipated severe illness at the start of the COVID-19 pandemic bought increased endorsement, awareness and provision of advance care planning in adults with serious illness. Place of death is often considered a surrogate quality indicator for end-of-life care.

Aim To examine the impact of advance care planning on place of death for patients who died during the COVID-19 pandemic with a Coordinate My Care (CMC) record, the Electronic Palliative Care Coordination System currently commissioned in London.

Methods Retrospective non-interventional cohort analysis of CMC records for patients aged over 18 who died between 20/03/20 and 05/03/21 with recorded place of death. Patient demographics, socio-economic position and advance care planning related factors associated with achieving preferred place of death were explored using logistic regression.

Results 11,913 records were included. 76.9% patients died in their preference place of death (57.7% Home, 31.4% Care Home, 7.5% Hospice, 3.3% Hospital, 0.1% Other). A higher likelihood of dying in the preferred place was associated with a ‘Not for resuscitation’ (DNACPR) status (OR=1.55, 95% CI 1.23 to 1.95), a Ceiling of Treatment for ‘Symptomatic Treatment’ (when compared to ‘Full active treatment’, OR=3.55, 95% CI 2.78 to 4.53), discussions with family regarding resuscitation recommendations (OR=1.53, 95% CI 1.34 to 1.74) and at least 2 non-urgent care record views in the 30days before death (OR=1.27, 95% CI 1.23 to 1.43). Patients from areas of lower socio-economic position had a decreased likelihood of dying in their preferred place (OR= 0.65, 95% CI 0.54 to 0.79).

Conclusion Components of Advance care planning carry potential to significantly influence place of death, even in times of crisis and when controlling for socio-economic and demographic determinants. Effective advance care planning is fundamental to achieving patient-centred, high-quality end-of-life care and factors relating to it must be considered in ongoing research on end-of-life outcomes.

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