Background End of life care (EoLC) and advance care planning (ACP) conversations can be challenging for staff and patients. Drawing on published guidance and building on previous local work1–4 this Trustwide project aims to improve the experience of patients, carers and staff in engaging with ACP discussions and to measure progress.
Method(s) This project is led by an ACP Nurse Specialist, overseen by the EoLC clinical lead and Deputy Head of Nursing. NHS Quality improvement methodology underpins the work which is supported by a steering group and governance structure.
Implementation of our previously developed ‘Let’s Talk’ resources (supporting information to aid understanding of ACP: videos, leaflet, website5), building stakeholder relationships, staff education, clinical visibility and role modelling were undertaken to increase engagement in ACP. A Gap Analysis Action Plan (GAAP) was developed by benchmarking against recommendations from the Care Quality Commission(2) and used at strategic and governance meetings to engage key stakeholders and agree measureable actions.
Data were collated from audits, patient and staff surveys and website viewing clicks.
Results Over 900 staff have received bespoke training. Changes from pre- to post-implementation include: increased awareness of and staff-reported use of materials (respectively 20%/ 90%; 21%/ 75%), increased staff confidence in ACP (30%/ 75%), increased documented use of materials to support cardiopulmonary resuscitation discussions (6%/ 9%). 65% of staff who used materials stated patients/families found them helpful. Website5 clicks increased (520/572) and staff webpage (270/424). Data show increased access to resources and what we hope is a meaningful and sustainable improvement to ACP.
Conclusion(s) Our data suggests that our approach to embedding use of our ‘Let’s Talk’ materials improves staff and patient engagement with ACP. More work is needed to fully develop our Trust framework including a focus on staff and patient education.
Talking about dying: How to have honest conversations about what lies ahead. Royal College of Physicians. October 2018. Available at: https://www.rcplondon.ac.uk/projects/outputs/talking-about-dying-how-begin-honest-conversations-about-what-lies-ahead [accessed 19/10/2022].
Protect, respect, connect – decisions about living and dying well during COVID-19. March 2021. Available at: www.cqc.org.uk/publications/themed-work/protect-respect-connect-decisions-about-living-dying-well-during-covid-19 [accessed 19/10/2022]
Universal Principles for Advance Care Planning. NHS England. March 2022. Available at: https://www.england.nhs.uk/publication/universal-principles-for-advance-care-planning/[accessed 19/10/2022].
Dying to Talk – Let’s Talk: Transforming End of Life Care Conversations. Guy’s & St Thomas’ NHS Foundation Trust. January 2019. Available at: www.guysandstthomas.nhs.uk/news/dying-talk [accessed 19/10/2022].
Let’s Talk: Advance Care Planning. Online resource and website – updated September 2022 www.guysandstthomas.nhs.uk/LetsTalk [accessed 19/10/2022].
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