34 Primary care and hospice engagement with patients to think, talk or act on current or future end of life needs: the THINK, TALK, ACT (TTA) pilot. (30th January 2023) - Brigden, Charlotte
Abstract : Introduction: Referral of patients to hospice care happens late. 1 Earlier referral leads to better outcomes at the end of life, 2 Patients with frailty are shown to be at greater risk of mortality, hospital admission and have low rates of advance care planning (ACP) in place. 3 It is not clear how best to support GP practices to engage with these patients, have the confidence to broker ACP conversations early. Aims: TTA is linking local hospice and primary care in one area of south-east England supporting people to plan their future care/wishes and early hospice referral. The pilot's aim was to determine how TTA works to refine the intervention and evaluation methods for future roll out. Methods: Moderately frail patients from two GP practices, identified through the electronic frailty index 4 were invited to a 'Think' information session about ACP. Invites were sent to 1050 patients; 88 attended one of 11 sessions (with 67 additional guests). Surveys with attendees/non-attendees, semi-structured interviews with a sample of attendees and GP practice staff, documentary analysis of the reflections of 'Think facilitators' were used to evaluate the 'Think' pilot. Results: 'Think' attendees (n=102), indicated that the session was informative and materials provided were useful to support ACP. They would like further support to help write their plans, navigate conversations with their GP/families. Findings indicated that review of the invitation letter is needed. Conclusions: 'Think' was acceptable to attendees, GP and hospice staff with some adjustments e.g. getting the wording in the invitation letter right was of particular importance. A larger roll out and evaluation of the programme to other areas over a longer timeframe to follow up patients would be recommended to understand if 'Think' has a positive effect on patient outcomes. A pilot of 'Talk' is currently underway. Impact: In the longer term it is anticipated that TTA could: increase the number of ACPs, increase patients accessing hospices services (and earlier) help patients achieve their preferred place of care/death. References: Allsop MJ, Ziegler LE, Mulvey MR, et al . Duration and determinants of hospice-based specialist palliative care: a national retrospective cohort study. Palliative Medicine 2018;32 (8):1322–1333. doi:10.1177/02692163187814172 GMC. (2010). 'Treatment and care towards the end of life: good practice in decision making'. https://www.gmc-uk.org/-/media/documents/Treatment_and_care_towards_the_end_of_life___English_1015.pdf_48902105.pdf (accessed 15/06/21). Hopkins SA, Bentley A, Phillips V, et al . Advance care plans and hospitalized frail older adults: a systematic review. BMJ Supportive & Palliative Care 2020;10 :164–174. Clegg A, Bates C, Young J, et al . Development and validation of an electronic frailty index using routine primary care electronic health record data. Age and Ageing 2016;45 (3):353–360. https://doi.org/10.1093/ageing/afw039