Year: 2025
Type: conference-paper
Study design: Observational Study
Abstract: Introduction Optimal end of life care (EOLC) should be supported by an individualised record of care, which supports communication, shared decision making and timely rationalisation of futile observations and medications. Aim This study aimed to assess the impact of the individualised record of care in supporting patients at the end of life at a UK tertiary cancer centre. Method In May 2024 we audited the case notes of 100 consecutive patients who received EOLC at our centre. Data regarding communication, clinical decision making and rationalisation were collected. Outcomes for those supported by an individualised record of care were compared to those who were not. Results 98 patient records were analysed. The presence of an individualised end-of-life record of care resulted in a statistically significantly increased rate of rationalisation of observations and medication in patients approaching the end of life [P<0.01]. 97.3% of patients with an individualised care record had their observations reviewed compared to 75% without, and 74.3% versus 41.7% for medications, respectively. Observations were more likely to be reviewed than medications overall, and certain medications e.g. prophylactic LMWH were less likely to be reviewed. Despite relatively high levels of rationalisation of observations and medication deprescribing at end of life, rates of documented communication and shared decision making were low (46.7% and 30.8%, respectively). Furthermore, discrepancies in timing of rationalisation and discussion were noted with some medications rationalised prior to discussions with patients and those important to them. Conclusion The presence of an individualised end-of-life record of care supported decision making, by improving rate of review and rationalisation of observations and medications in patients approaching the end of their lives. However, communication was often secondary to the fact, particularly with medication reviews. Further work is needed to investigate shared decision making processes in patients approaching end of life.
Source: Poster presentations
Institution: University of Liverpool
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4408550633