46 Evaluation of advance care planning discussions in a community palliative care setting

<h3>Background</h3> Adults nearing the end of life should have opportunities to engage in advance care planning (ACP) discussions (NICE QS2, 2021). This should be a holistic approach involving both hospital and community care teams. This evaluation assessed the extent to which this standard was met among patients seen by a specialist community palliative care team, focusing on the frequency, initiation and content of advance care planning (ACP) discussions. <h3>Methods</h3> The electronic patient records for patients who entered the service between 7th February and 17th May 2024 were reviewed for evidence of ACP discussions before and during the care episode. This included direct evidence (ReSPECT form, just in case [JIC] medications and electronic end of life [EOL] template completion) and indirect evidence (clinician notes). <h3>Results</h3> 54 patients were reviewed by the community palliative care team during this time. Before entering the service, 78% of patients had indirect evidence of ACP discussions, mostly with hospital teams. Fewer had direct evidence: 52% had ReSPECT forms, 46% had JIC medications and 24% had EOL templates. During the care episode, ACP completion increased: 87% of patients had ReSPECT discussions, an additional 31% had JIC medications added and 72% had EOL template completed. 82% of patients had indirect evidence of ACP discussions recorded, the majority during initial assessment. Most ACP discussions were clinician initiated (55%), often addressing emotional distress, rapid physical deterioration or psychological concerns. Discussions took place an average of 27 days before death. <h3>Conclusion</h3> This evaluation showed that the majority of patients entering the service had already started ACP discussions with primary or secondary care. Specialist palliative care teams played a role in initiating, revisiting and completing ACP discussions, particularly in response to patient or carer distress and physical deterioration. Further focus is needed on addressing spiritual aspects of care.