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Advance care planning for the end of life

13 April 2012

The initiation of advance care planning for those entering end of life care is the subject of a new study funded by the NIHR Health Services and Delivery Research (HS&DR) programme.

The delivery of excellent and cost-effective care to dying patients and their families is a pressing issue for the NHS.

Advance care planning (ACP) is the process whereby a patient, in communication with health care professionals, family members and important others, makes and reviews decisions about future health care, should he or she subsequently become incapable of participating in these treatment decisions. ACP is the first step in implementing the End of Life Care Pathway set out in the National End of Life Care Strategy.

The collaborative research by University of Nottingham academics and senior palliative care clinicians will look into the ways in which ACP is used in community care settings and how this affects patients’ experience of end of life care.

The process of ACP aims to start the discussion about end of life care as early as possible after a terminal prognosis, by bringing together patients, carers and healthcare professionals. Starting ACP discussions is often difficult for participants and evidence suggests that patients and professionals tend to wait for each other to take the initiative. Very little is known about patient and carer preferences for ACP, or how it is implemented and develops as a process over time.

The research team, led by Dr Kristian Pollock of the University of Nottingham, will investigate the ACP process through a series of qualitative interviews with healthcare professionals and longitudinal patient-centred case studies.  This will be supported by analysis of patients’ medical records and other documents recording ACP discussions.

Describing the project, Dr Pollock said: “Evidence suggests that ACP can reduce the number of unscheduled, costly and distressing hospital admissions and increase the likelihood that patients are able to die in their preferred place. Even so, ACP remains uncommon and very little is known about the timing, nature or quality of end of life care discussions that occur.  This knowledge will help to shape the best care for patients in community settings at the end of life."

This project was commissioned by the NIHR Health Services Research (NIHR HSR) programme under the management of the National Institute for Health Research Evaluations, Trials and Studies Coordinating Centre (NETSCC) based at the University of Southampton.  

Visit the project page for more information.

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The NIHR Health Services and Delivery Research (HS&DR) Programme is managed by the NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC). NETSCC is part of the University of Southampton funded by the NIHR, with specific contributions from the CSO in Scotland and NISCHR in Wales and the HSC R&D Division, Public Health Agency in Northern Ireland.

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