978 ADVANCED CARE PLANNING IN PATIENTS WITH PARKINSONIAN DISORDERS. (14th June 2022)

• Record Type: Journal Article
• Authors: Lonsdale-Eccles, E; Peters, A; Richfield, E
• Is Part Of: Age and ageing. Volume 51(2022)Supplement 2
• Publication Date: 2022-06-14
• Subjects: Aging -- Periodicals; Geriatrics -- Periodicals; 618.97
• DOI: 10.1093/ageing/afac126.034
• Languages: English
• ISSNs: 0002-0729

Abstract

Abstract: Introduction: Advanced care planning (ACP) supports individuals to make decisions regarding their future care. Guidelines (NICE, 2017) recommend offering ACP discussions to people with Parkinson's Disease (PD), but uptake lags behind other countries (Sokol, NPJ Parkinson's Dis, 2019, 22:5–24). As part of a project to improve ACP in the community we audited ACP practice at North Bristol NHS Trust. Method: Records for 100 patients with idiopathic PD or atypical Parkinsonian syndromes seen in Movement Disorders clinics from March to October 2021 were scrutinised. ACP was defined as including: Do not attempt cardio-pulmonary resuscitation (DNACPR), Advanced Statement of Wishes, Advanced Decision to Refuse Treatment (ADRT) and Lasting Power of Attorney (LPOA). Disease severity was assessed using Hoehn and Yahr (H&Y) score. Results: 87 records were audited, 13 were excluded due to non-Parkinsonian disorders (11) or unavailable records (2). ACP was completed for 22 (25%) cases, (18 DNACPR and 11 Advanced Statements, 1 LPA, 0 ADRT). Informal ACP, such as documentation of wishes in clinic letters, were present in 5 cases. Of the 22 instances of ACP, 20 were recorded on Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms. Preferences included ventilation (10), hospital admission (6), life prolonging treatments (6), preferred place of care (4), nutrition (0). Completed ACP was associated with higher H&Y scores or atypical syndromes. Conclusion: It is recognised that there is a need to further investigate how ACP is delivered for patients with Parkinsonian Disorders. Three US studies estimated ACP rates ranging from 14.6%–53%. (Nimmons, European Journal of Neurology 2020, 27:1971–1987). We are not aware of any comparable UK data. This is a preliminary audit for a project to improve ACP within our MD Service. We are collecting further data on the views of our community movement disorders team with a view to upskilling in ACP.