PP07.003 Why do some people record place of death preferences and some not? Analysis from an electronic palliative care coordination system

ABSTRACT

BackgroundConsideration and documentation of where individual patients want to die is an important component of advance care planning and helps facilitate care aligned with patients' wishes.AimTo examine factors associated with recording a preferred place of death in Coordinate My Care, a large Electronic Palliative Care Coordination System in London.MethodsAdults with a Coordinate My Care Record, between 01/01/2018 and 05/03/2021 were included. Logistic regression modelling was used to identify clinical, social and demographic factors associated with documenting preference for place of death. Timing of record creation (pre and during the Covid-19 pandemic) was also included.Results72,591 records were analysed (52,006 (71.6%) with a recorded preferred place of death and 20,585 (28.4%) without). Individuals with a recorded preferred place of death were more likely to be older (Aged 80+ compared to <80) OR 1.19, CI 1.14 – 1.24), less functionally independent (WHO performance status 4 compared to 1, OR 1.28, CI 1.19 – 1.37), have a ‘Do Not Attempt Cardio-Pulmonary Resuscitation' status (OR 1.70, CI 1.60 – 1.80), be from least deprived areas (compared to most deprived, OR 1.08, CI 1.01 – 1.16), live in a care home (OR1.42, CI 1.35 – 1.50), create their record in the General Practice setting (compared to at an hospital setting OR 1.42, CI 1.34 – 1.53) and have created their record during the initial wave of the pandemic (compared to pre-pandemic OR 1.56, CI 1.49 – 1.63).ConclusionsHealth status, living and socio-economic circumstances and the Covid-19 pandemic were associated with whether or not patients had a documented preference for place of death. This has implications for professional training and patient empowerment in terms of having conversations about what matters most to patients at the end of life and how to provide patient centred end-of-life care.