Advance Care Plans: Creation, Content and Use During Wave 1 of the COVID-19 Pandemic. A Retrospective Cohort Study of Coordinate My Care, a Large Electronic Palliative Care Coordination System

ABSTRACT

Background/aims: Mortality forecasts associated with COVID-19 pandemic stressed a need to prepare adults with advanced disease for possible severe illness and engage with Advance Care Planning (ACP). We aimed to examine ACP engagement and activity during the COVID-19 pandemic. Methods: A retrospective non-interventional cohort study, comparing the creation, content and use of Coordinate My Care (CMC) records that include an ACP component, in London, prior to and during the onset of COVID-19. Records for people aged 18+, created and published in prepandemic period (2018-2019) and 'wave 1' (W1) of COVID-19 (20/03/20- 04/07/20) were extracted. Demographics, ACP-related content and the use of CMC records created were analysed and compared using standard descriptive statistics. Results: 56,343 records were included, 35,108 from the pre-pandemic period and 21,235 records from W1. The average records created each week rose by 296.9% (P<0.005) in W1. There were fewer records in W1 for those aged 80 years (60.8% vs 64.9% pre-pandemic, P<0.005) and who had WHO performance status of 4 (34.8% vs 44.2% pre pandemic, P<0.005). More people who created records during W1 had an estimated prognosis of at least a year (73.3% vs 53.0% pre-pandemic, P<0.005), were “For Resuscitation” (38.2% vs 29.8% pre-pandemic, P<0.005) and had a Ceiling of Treatment of “Full Active Treatment” (32.4% vs 25.7%, P<0.005). More people in W1 listed hospital as their preferred place of care (PPC) and preferred place of death (PPD) (PPC 13.3% vs 5.8% pre-pandemic, P<0.005. PPD 14.0% vs 7.9%, P<0.005). Average monthly non-urgent and urgent record views rose by 320.3% (P=0.02) and 154.3% (P=0.01) in W1. Conclusions: A large uptake in engagement with ACP is demonstrated during the 1st wave of the pandemic. An increase in use among younger, more independent patients with longer prognoses, with a higher preference for hospital care creating records in W1 compared to before the pandemic, suggests heightened awareness and provision of ACP at this time.