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BOS4c.003 Advance care plans: creation, content and use during wave 1 of the COVID-19 pandemic
  1. Philippa McFarlane,
  2. Catey Bunce,
  3. Katherine E Sleeman,
  4. Martina Orlovic,
  5. Jonathan Koffman,
  6. John Rosling,
  7. Alastair Bearne,
  8. Margaret Powell,
  9. Julia Riley and
  10. Joanne Droney
  1. The Royal Marsden NHS Foundation Trust, London, UK


Background Mortality forecasts associated with COVID-19 stressed a need to prepare adults with advanced disease for possible severe illness and engage with Advance Care Planning (ACP). We aimed to examine ACP engagement and activity during the COVID-19 pandemic.

Methods A retrospective cohort study, comparing the creation, content and use of Coordinate My Care (CMC) records in London prior to and during the onset of COVID-19. Records for people aged 18+, created and published in pre-pandemic period (2018–2019) and ‘wave 1’ (W1) of COVID-19 (20/03/20–04/07/20) were extracted. Demographics, ACP-related content and the use of CMC records created were analysed and compared using descriptive statistics.

Results 56,343 records were included, 35,108 from the pre-pandemic period and 21,235 records from W1. The average records created each week rose by 296.9% (P<0.005) in W1. There were fewer records in W1 for those aged 80 years (60.8% vs 64.9% pre-pandemic, P<0.005) and who had WHO performance status 4 (34.8% vs 44.2% pre pandemic, P<0.005). More people who created records during W1 had an estimated prognosis of 1 year+ (73.3% vs 53.0% pre-pandemic, P<0.005), were ‘For Resuscitation’ (38.2% vs 29.8% pre-pandemic, P<0.005) and had a Treatment Ceiling of ‘Full Active Treatment’ (32.4% vs 25.7%, P<0.005). More people in W1 listed hospital as their preferred place of care (PPC) and preferred place of death (PPD) (PPC: 13.3% vs 5.8% pre-pandemic, P<0.005. PPD: 14.0% vs 7.9%, P<0.005). Average monthly non-urgent and urgent record views rose by 320.3% (P=0.02) and 154.3% (P=0.01) in W1.

Conclusions A large uptake in engagement with ACP is demonstrated during the 1st wave of the pandemic. An increase in use among younger, more independent patients with longer prognoses, with a higher preference for hospital care creating records in W1 compared to before the pandemic, suggests heightened awareness and provision of ACP at this time.

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