Introduction Referral of patients to hospice care happens late.¹ Earlier referral leads to better outcomes at the end of life,²Patients with frailty are shown to be at greater risk of mortality, hospital admission and have low rates of advance care planning (ACP) in place.³ It is not clear how best to support GP practices to engage with these patients, have the confidence to broker ACP conversations early.

Aims TTA is linking local hospice and primary care in one area of south-east England supporting people to plan their future care/wishes and early hospice referral.

The pilot’s aim was to determine how TTA works to refine the intervention and evaluation methods for future roll out.

Methods Moderately frail patients from two GP practices, identified through the electronic frailty index⁴ were invited to a ‘Think’ information session about ACP. Invites were sent to 1050 patients; 88 attended one of 11 sessions (with 67 additional guests).

Surveys with attendees/non-attendees, semi-structured interviews with a sample of attendees and GP practice staff, documentary analysis of the reflections of ‘Think facilitators’ were used to evaluate the ‘Think’ pilot.

Results ‘Think’ attendees (n=102), indicated that the session was informative and materials provided were useful to support ACP. They would like further support to help write their plans, navigate conversations with their GP/families. Findings indicated that review of the invitation letter is needed.

Conclusions ‘Think’ was acceptable to attendees, GP and hospice staff with some adjustments e.g. getting the wording in the invitation letter right was of particular importance.

A larger roll out and evaluation of the programme to other areas over a longer timeframe to follow up patients would be recommended to understand if ‘Think’ has a positive effect on patient outcomes. A pilot of ‘Talk’ is currently underway.

Impact In the longer term it is anticipated that TTA could:

• increase the number of ACPs,

• increase patients accessing hospices services (and earlier)

• help patients achieve their preferred place of care/death.

References

1. Allsop MJ, Ziegler LE, Mulvey MR, et al. Duration and determinants of hospice-based specialist palliative care: a national retrospective cohort study. Palliative Medicine 2018;32(8):1322–1333. doi:10.1177/02692163187814172

2. GMC. (2010). ‘Treatment and care towards the end of life: good practice in decision making’. https://www.gmc-uk.org/-/media/documents/Treatment_and_care_towards_the_end_of_life___English_1015.pdf_48902105.pdf (accessed 15/06/21).

3. Hopkins SA, Bentley A, Phillips V, et al. Advance care plans and hospitalized frail older adults: a systematic review. BMJ Supportive & Palliative Care 2020;10:164–174.

4. Clegg A, Bates C, Young J, et al. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age and Ageing 2016;45(3):353–360. https://doi.org/10.1093/ageing/afw039