P-30 Advance care plans: creation, content and use during wave 1 of the COVID-19 pandemic. an analysis of data from coordinate my care, a large electronic palliative care coordination system. (20th March 2022)

• Record Type: Journal Article
• Authors: McFarlane, Philippa; Bunce, Catey; Sleeman, Katherine E; Orlovic, Martina; Rosling, John; Bearne, Alastair; Powell, Margaret; Riley, Julia; Koffman, Jonathan; Droney, Joanne
• Is Part Of: BMJ supportive & palliative care. Volume 12(2022)Supplement 2
• Page Start: A20
• Page End: A20
• Publication Date: 2022-03-20
• Subjects: Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/spcare-2022-SCPSC.51
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Background: Mortality predictions as the COVID-19 pandemic began highlighted a need to prepare adults for possible severe illness, encouraging engagement with Advance Care Planning (ACP). Aim: To explore ACP activity and engagement during the COVID-19 pandemic. Methods: A retrospective cohort study, comparing the creation, content and use of Coordinate My Care (CMC) records, the Electronic Palliative Care Co-ordination System in London, during and prior to the onset of COVID-19. Records for patients aged 18+, created and published in the pre-pandemic period (2018–2019) and 'wave 1' (W1) of COVID-19 (20/03/20–04/07/20) were included. Demographics, the ACP-related content, and the use of CMC records created were compared using descriptive statistics. Results: 56, 343 records were included (35, 108 pre-pandemic period and 21, 235 W1). During W1, the mean records created each week increased by 296.9% (P<0.005). More people creating records at this time were aged below 80 (39.9% vs 35.1% pre-pandemic, P<0.005) and had WHO performance status 0–1 (17.7% vs 11.63% pre pandemic, P<0.005). Less people who created records during W1 had an estimated prognosis of days - weeks (9.0% vs 16.7% pre-pandemic, P<0.005), were 'Not For Resuscitation' (61.8% vs 70.3% pre-pandemic, P<0.005) and had a Ceiling of Treatment of 'Symptomatic Treatment Only' (8.1% vs 14.0%, P<0.005). More patients 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. Conclusion: A marked increase in ACP activity is shown during wave 1 of the pandemic. Amplified engagement, provision and awareness at this time is suggested by increased use among younger, more independent patients with longer prognoses and a higher preference for hospital care creating records in W1 compared to before the pandemic.