29 Discussions of preferred place of death in secondary care during the COVID-19 pandemic

ObjectivesAchieving Preferred Place of Death (PPD) may form part of a ‘good death’ for some patients and loved ones. In many circumstances, it may not be possible to facilitate a death outside of hospital during the COVID-19 pandemic but this does not exclude the need for constructive discussions of PPD in order to address this. The aim of this audit is to determine whether PPD is being discussed in a secondary care setting alongside Treatment Escalation Plans (TEPs) and explore influencing factors.MethodsNotes of 20 patients who died in Aneurin Bevan Health Board during the COVID-19 pandemic were audited for discussions of PPD and TEPs.ResultsEven in cases where patients remained stable after the decision for supportive care was made, only in one case was PPD discussion documented. In contrast, in almost all cases there was a DNAR in place that was also discussed with the patient and/or family.ConclusionsDiscussing TEPs is not necessarily the equivalent of robust joint decision-making. As we continue to manage dying patients during the pandemic, factors influencing PPD discussions in view of the wider context of end-of-life discussions should be considered. There is scope for research into how the COVID-19 pandemic has influenced or changed the quality of end-of-life discussions in secondary care to ensure patient-centred care moving forward.