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127 The changing landscape of advance care planning: a multi-centre study comparing practice in 2014 to 2017
  1. Louisa Nelms,
  2. Anna Lock and
  3. Sarah Bache
  1. Members of Specialist Palliative Care Audit and Guideline Group (SPAGG) including Birmingham St. Mary’s Hospice, Heart of England Foundation Trust, John Taylor Hospice, Marie Curie Hospice West Midlands, Sandwell Hospital, Sandwell community team, Walsall Community Team


Background Advance care planning (ACP) is an important part of holistic care for palliative patients. Previous studies suggest that engagement in ACP improves patient and family satisfaction with care at end-of-life.

Methods Ten specialist palliative care organisations across Birmingham contributed data to a retrospective study – designed and co-ordinated by the local Specialist Palliative Care Audit and Guideline Group (SPAGG) – across all settings including hospice inpatients, community and hospital. Data from 166 patients known to these services was collected using an electronic data collection form. The results were compared to a similar sample taken in 2014, and conclusions were drawn.

Results This study found the number of patients with a documented resuscitation status, preferred place of care and death had increased from 2014. Specifically, 81% had a preferred place of death documented in 2017 compared to 58% in 2014. Preferred place of death was achieved for 66% of patients in 2017 compared to 30% in 2014. In contrast, the number of patients completing a hand-held document of their wishes was 14% in 2017 which had fallen from 24% in 2014. Also, documented information was less likely to be shared with other health professionals including ambulance and out of hours services in 2017 compared to 2014.

Conclusions Rates of discussions of resuscitation, preferred place of care and death have increased since 2014. As a consequence, an increased number of patients achieved their preferred place of death. This is likely due to increasing organisational and political focus on avoiding unwanted hospital deaths and staff training to improve skills and confidence in these areas. The decrease in the number of patients with a hand-held document and lack of data sharing suggests opportunities for SPAGG to focus on supporting consistent implementation of a hand-held tool and improved communication across the locality.

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