Background Advance care planning (ACP), with particular reference to care home residents, has been brought to the fore by the COVID-19 pandemic, with concern over residents’ involvement in resuscitation decisions leading to a review by the Care Quality Commission (2021). Whilst recently published Universal Principles (NHS England. 2022) will be helpful, achieving high quality ACP consistently with impact and at scale has proved elusive. In response to this need we piloted an innovative ACP service for capacitous care home residents; delivered remotely by trained volunteers to include treatment escalation plans.
Aims To evaluate our ACP service with reference to: a) concordance between treatment escalation decisions made by residents when supported by a volunteer compared to a GP; b) time taken by volunteers and GPs; c) acceptability of remote ACP in this population; d) feedback on the service from GPs, residents and care home managers.
Methods Apr – June 2020: service set up with PCN leads’ support, recruitment and training of volunteers (counsellors and medical students), partial funding from West Yorkshire & Harrogate Health Inequalities Fund. Residents completed an ACP with a volunteer which was then re-discussed with GP. July 2020: Pilot commencement with data collection on time taken, outcomes and feedback questionnaires to all involved. Service evaluation after 25 appropriate referrals.
Results 95% concordance in escalation plans created with volunteer compared to GP. Average time taken; volunteer 52 mins, GP 12 mins. 100% of residents found the service useful and would recommend to others, with 88% finding the remote platform acceptable. The GPs reported the service as being useful for 96% of referrals.
Conclusion An ACP service for capacitous care home residents delivered remotely by trained volunteers is feasible and acceptable. This has the potential to allow GPs, or clinicians within an ACP service, to reduce down the time taken by building on volunteer-led ACPs or concentrate on complex ACP decisions where clinical input is needed.
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