ObjectiveIn an attempt to address the findings of the CQC report ‘A different ending – addressing inequalities in end of life care’, we interviewed family members of patients on Care of the Elderly wards in our trust. Our aim was to ascertain their views about hearing prognostic information.MethodWe interviewed family members who had told ward staff they were happy to speak to us. We used vignettes to aid discussion and explained we did not know the details of any ward patients. We wrote copious notes which were then analysed to produce a summary of participants’ views, supported by verbatim quotes.ResultsWe spoke to 9 relatives (three wives, three siblings, two sons and one son-in-law) and one patient. Key themes identified were: families welcome prognostic information since it allows them to feel prepared and prioritise their time – some would feel relieved to hear that time could be short; relatives have strong feelings about the appropriateness of medical treatments and do not always hope for active treatment, but are mostly guided by medical staff; given the choice relatives would wish the patient to be given the opportunity to receive end of life care at home.ConclusionsRelatives (and one patient) told us they would welcome a pro active approach to the recognition of a patient approaching the end of life. They would also wish information regarding prognosis to be shared with the GP, even if it was not information the patients themselves wished to have. No funding was obtained for this study.

BackgroundThe NHS End of Life Care Council advises that end of life (EoL) discussions should be offered to patients with chronic obstructive pulmonary disease (COPD) who have certain poor prognostic markers. EoL conversations with advanced care planning can reduce a patient's anxiety during an exacerbation, allow informed decisions about what treatment they would (or would not) like to receive in the future, reduce unnecessary or unwanted hospital admissions, and enable patients to die in their preferred place.AimsTo assess whether patients who are admitted to a respiratory ward with exacerbations of COPD, who fulfill the criteria, have been offered the opportunity to have such discussions. Secondary aims included (i) patient engagement, (ii) communication of outcomes (iii) communication of DNACPR orders.MethodsAudit of all patients admitted to a respiratory ward with an exacerbation of COPD, within a 3 month period. Specifically looking for evidence of EoL conversations during the current admission, previous admission or clinic appointments.ResultsOf 48 patients admitted with an exacerbation of COPD, 20 fulfilled the criteria to be offered EoL conversations. The 3 month mortality of these 20 patients was 25%. Three patients (15%) had documented EoL conversations. One lead to the formation of an advance directive not to return to hospital, one described a patient's wish to have no further non-invasive ventilation, and one where a patient wanted full treatment escaltion in the future. Seventeen of the 20 patients were made DNACPR, however, only 4 had this communicated to the GP.RecommendationsIdentify patients on hospital board rounds that may be suitable for end of life discussions. If patients engage with EoL discussions this should be documented in the medical notes as well as the discharge summary. Further use of an existing “Poor prognostic indicators” letter, which is sent to the GP, noting engagement in EoL discussions and decisions around DNACPR orders.