A Princess Margaret Cancer Centre (PM) initiative to redefine the use of the end-of-treatment bell.

384 Background: Ringing a bell or gong at the end of cancer treatment is a long-standing tradition in many cancer centers, symbolizing a significant milestone for patients, their caregivers, and staff. However, for patients who may never complete treatment, experience recurrence, or are on lifelong medications, the sound of the bell can be distressing. We sought stakeholder input to develop guidance for celebrating cancer care milestones within an ethical framework. Methods: A 9-question survey with both quantitative and qualitative fields was disseminated to both patients and staff to assess the value of bell ringing, the location of bells, and their use beyond the end of treatment. The survey was initially pilot-tested in one unit and subsequently adjusted. The final survey was distributed to leaders and various patient groups (both online and paper) over a one-month period. Descriptive statistics were used to analyze the results. Key findings were discussed with leadership teams to develop a guidance document. Results: A total of 101 patients and 28 staff completed the survey. Most staff opted not to complete the survey as the patient voice was deemed to be more important. The majority of patients (85%) and staff (75%) supported the idea of ringing a bell or gong to celebrate while at the cancer centre. Most respondents felt the bell should be located in a semi-private area within inpatient and outpatient units. Additionally, 60% of patients agreed/strongly agreed that the bell should mark any significant milestone beyond end of treatment, in comparison to 32% of staff. Staff felt the bell should primarily mark the end of treatment. Qualitative comments indicated redefining the bell would need clear guidance and instructions. A guidance document was developed to aid in celebrating any patient milestone inclusive of 1. cancer milestones such as marking another year living with cancer, 2. changes in treatment (e.g., switching to palliative care), 3. making important decisions, such goals of care decisions and 4. completion of treatment. Patients are invited to ring the bell more than once if they reach several milestones. Conclusions: Engaging patients is crucial to understanding sensitivities surrounding the end-of-treatment tradition. Patients' perspectives differed from those of staff, who may be unaware of the range of emotions experienced by patients waiting in a busy clinic setting. Standardized guidance to redefine the use of the bell beyond the end of treatment was supported by the majority of patients. Consideration should be given to the bell's location if moving beyond treatment, rebranding, and broad communication of these changes to ensure effective implementation. This abstract highlights the importance of patient engagement to develop processes that promote health and healing in a cancer centre.