ABSTRACT
Following an increased need for individual patient escalation plans during the COVID-19 pandemic we recently created a working group to embed Advance Care Planning (ACP) into our service. Modern ACP is not only about end-of- life planning, it involves meaningful conversations and supporting patients to make decisions throughout all stages of their disease and treatment. With early conversations and the opportunity to pre plan, the stress and anxiety attached to the difficult decisions at a time when someone may be acutely unwell should become easier (from the perspective of both staff and patients). We carried out a preproject audit to ascertain patient opinions on how we could embed ACP into our service. 50 patients were offered a questionnaire, 38 chose to partake. Result(s): 100% (38) of patients had never been approached by a nurse to discuss ACP. 82% (31 out of 38) said they would not want to be approached about ACP. 18% (7 pts) would like to be approached but 13% (5pts) noted only if end of life. On asking when the best time to be approached: three patients said 'at diagnosis', two said 'anytime', one said 'never', five said 'when ready' and seven said 'end of life only'. Suggestions on the best way to raise ACP issues, five said poster displays (one noting the need for this poster to be positive and also available in Welsh), four suggested routine discussions in the current appointment and five people suggested a separate appointment. Other comments included, I only want to discuss these issues with my solicitor, I would like my family to be involved, make sure the nurses can answer questions. Average age was 68.5 years (range 49-85). Discussion(s): This was a limited audit on an outpatient population, but it raised a number of important issues. The actual carrying out of an audit on an emotive subject highlighted one the difficulties of embedding ACP initiatives into a service with a quarter of patients choosing not to answer the questionnaire, and of those who chose to answer 83% said they did not necessarily want to be approached to discuss ACP. In addition, the terminology 'ACP' appeared confusing, many people linking it to end-of- life discussions or to legal aspects such as writing of Wills. The barriers this audit has highlighted, has helped to shape the future direction of our working group and highlighted the need for increased training.