Documenting advance care planning in the hospice setting

Abstract

IntroductionThe Hospice of St Francis piloted advance care planning (ACP) documentation (September 2010 – February 2011). The pilot was in four phases including a consultation group, agreement re documents to be used, staff training required, target areas and numbers (up to 10 patients per In Patient Unit, Day Care and Community Specialist Nursing team).AimTo establish whether there was a need for Hospice of St Francis specific ACP documentation.MethodsPhases▶Multiprofessional working group to discuss, produce and pilot ACP documentation▶Evaluation of pilot and amend documents▶Implement amended documents over 6 months▶Evaluation and re-evaluate documentation.ResultsDocumentation was implemented with two community and three day care patients.Discussion▶Do the results reflect the need for more staff education or more confidence in using the skills and documents?▶Do the results relate to the voluntariness or fragility of patients in the advance care planning process or reticence of staff to use ACP documents?▶What is the impact of other ACP work in the hospice on this pilot (eg, ACP letters for patients with advanced respiratory and cardiac disease, ACP research interviews as part of a doctoral research programme).ConclusionThe ACP document pilot shed light on the process and documentation of ACP. Further work has subsequently been done to look at an ACP education model for Beds and Herts as well as ACP resources for care homes. It is important not to make assumptions about the skills and confidence of hospice staff in ACP as well as looking at the context of the patient's voluntariness and fragility. The pilot helped us look at the education needs of our staff.