Background UK government policy supports advance care planning and recording of patient preferences on EPaCCs (Department of Health, 2008). EPaCCs have been developed across the country but there is no consensus on evaluation (Allsop, Kite, McDermott, Penn et al., 2017) and assessments are urgently required (Petrova, Riley, Abel & Barclay, 2016; Callender, Riley, Broadhurst, Wiggins et al., 2017).
Aim This evaluation reviews the first five years of EPaCCS in North East Essex, locally called the My Care Choices register (MCCR) including; uptake of the register; the process of register entry before death and preferred place of care choices and outcomes. This is to contribute to the discussion about how EPaCCs should be evaluated and developed.
Method Data was extracted from MCCR from the date of inception in September 2013 to September 2018. Data recorded on the EPaCCS for residents of North East Essex were compared to Office for National Statistics mortality data to calculate what proportion of deaths had a register entry. The mean number of days prior to death that the register entry was created was calculated. Extraction of data included preferred place of care and subsequent achievement.
Results 8978 people in North East Essex recorded a register entry in the first five years of My Care Choices. The mean number of days to death from the initiation of a MCCR entry increased from 65 in year one, to 316 in year five. The proportion of people in North East Essex who died with a MCCR record increased from 20% in year one to 46% in year five. Preferred places of care were recorded for 81% of register entries. Of these 52% were home, 36% care home, 8% hospice, 3.5% hospital, 0.5% community hospital. Achievement of first choice preferred place of care was 70%.
Conclusion EPaCCs have potential to promote care consistent with peoples’ preferences towards the end of life. Opportunities should be taken to develop systematic evaluations to drive improvement.
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