B142
Advance care planning: lessons from three research projects in different settings
Scott Murray1, Bruce Mason1, Jo Hockley3, Deirdra Sives2
1University of Edinburgh, UK, 2Strathcarron Hospice, Denny, Stirlingshire, UK, 3St. Christopher's Hospice, London, UK
Background
The succession of recent policy developments in Advance Care Planning (ACP) throughout the UK has been described as a juggernaut. Research as to when, where, how and by whom ACP can be effectively carried out is underdeveloped. We implemented and evaluated ACP in three different settings: primary care, specialist community palliative care, and in care homes.
Method
We used qualitative longitudinal methods in order to ascertain the experience of implementing ACP among the staff, patients and carers involved. Semi-structured interviews with participants were followed by interventions which were evaluated through follow-up interviews. In the primary care study, GPs and district nurses received an in-house training workshop and document tool-kit. The specialist palliative care nurses attended focus groups, received an orientation about ACP and a document template to record patient preferences. In the care home study, staff were trained to perform ACP routinely on patient admission. Interviews were recorded, transcribed and thematically analysed.
Results
The primary care and specialist nurse team projects highlighted substantial barriers to instigating ACP. Professionals were concerned about the risk of diminishing hope by performing ACP too early, and the risk of end-of-life care becoming a tick-box exercise. The care homes study however demonstrated that integrating ACP discussions into routine working practice at admission led to high uptake and better patient outcomes.
Conclusion
Patients, carers and professionals were enthusiastic about the principle of ACP, but the research demonstrated that implementing it requires careful attention to the setting, current working practices and the patients condition. ACP is not a one size fits all process and further developments will need to be informed by a wider understanding of the challenges professionals face in implementing it as well as the responses of patients and their carers to the process.
