Background Escalation planning including decisions regarding CPR and higher levels of care should be made in advance wherever possible. A Treatment Options Form was devised in Sheffield to promote and aid the documentation of escalation planning for patients with life limiting conditions. We sought to increase the use of this form within a tertiary oncology centre, with the hope of improving the number of timely advance care decisions.
Methods We included 135 patients from August 2016 to May 2017. We completed data collection at baseline and then a further four data cycles after each of the following interventions:
introduction of form into clerking pack for new patients
training to new junior doctors at induction
presentation to consultants and questionnaire to glean barriers to usage of form
ensured all patient notes contained a treatment option form.
We looked at all discharges within the pre-defined data collection window (1 week per data cycle), including only those who had originally been admitted as an emergency. The notes were analysed retrospectively and data analysed using excel.
Results Documentation of escalation plans increased from 13% – 52%; of these, discussions with relatives increased from 50% – 83%. Setting of these plans within 24 hours of admission increased from 7% – 13% and use of the Treatment Options Form increased from 7% – 48%. Feedback from questionnaires suggested that barriers to implementing advance planning included time pressures and reluctance of acute teams to make decisions for patients not under their outpatient follow up.
Conclusions Implementing a Treatment Options Form has improved the numbers of advance care decisions for patients in the oncology setting. We have identified some of the barriers to these decisions being made. Further work to elucidate how best to overcome these is required.
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