80 Does having an individualised end-of-life care record actually make a difference?

<h3>Introduction</h3> Optimal end of life care (EOLC) should be supported by an individualised record of care, which supports communication, shared decision making and timely rationalisation of futile observations and medications. <h3>Aim</h3> This study aimed to assess the impact of the individualised record of care in supporting patients at the end of life at a UK tertiary cancer centre. <h3>Method</h3> In May 2024 we audited the case notes of 100 consecutive patients who received EOLC at our centre. Data regarding communication, clinical decision making and rationalisation were collected. Outcomes for those supported by an individualised record of care were compared to those who were not. <h3>Results</h3> 98 patient records were analysed. The presence of an individualised end-of-life record of care resulted in a statistically significantly increased rate of rationalisation of observations and medication in patients approaching the end of life [P&lt;0.01]. 97.3% of patients with an individualised care record had their observations reviewed compared to 75% without, and 74.3% versus 41.7% for medications, respectively. Observations were more likely to be reviewed than medications overall, and certain medications e.g. prophylactic LMWH were less likely to be reviewed. Despite relatively high levels of rationalisation of observations and medication deprescribing at end of life, rates of documented communication and shared decision making were low (46.7% and 30.8%, respectively). Furthermore, discrepancies in timing of rationalisation and discussion were noted with some medications rationalised prior to discussions with patients and those important to them. <h3>Conclusion</h3> The presence of an individualised end-of-life record of care supported decision making, by improving rate of review and rationalisation of observations and medications in patients approaching the end of their lives. However, communication was often secondary to the fact, particularly with medication reviews. Further work is needed to investigate shared decision making processes in patients approaching end of life.