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Abstracts: John Ellershaw

Professor John Ellershaw, Professor of Palliative Medicine, University of Liverpool

Conversations and Advance Care Planning in end of life care – a challenging interface?

This paper will look at definitions around advance care planning, palliative care, and end of life care, and discuss issues around the development of the Advance Care Planning (ACP) Framework and its implementation in a care home setting.

The topics of future care and future care planning are part of everyday conversation with patients in medical practice, but the complexity of implementing Advance Care Planning (ACP) documentation into healthcare settings should not be underestimated; nor should the importance of education and training for healthcare practitioners involved in these conversations, particularly in relation to communication skills.

In Cheshire and Merseyside, the Marie Curie Palliative Care Institute at the University of Liverpool (MCPCIL) led a project to develop and Advance Care Planning (ACP) Framework (http://www.nwcscnsenate.nhs.uk/files/1414/4059/6386/Advance_Care_Planning_Framework_2015-18_FINAL.pdf). As part of this, a model was developed which identified formal, informal and clinical future care planning, supported by the Electronic Palliative Care Co-ordination System (EPaCCS).

ACP was implemented in a care home setting, together with an education and training programme and research and evaluation. The outcome of the project demonstrated that conversations should be timely and responsive to the needs and wishes of the resident, appropriate formal documentation should be disseminated to all those relevant in the current and future care of the resident, and that planned reviews should be built into the process. Key to supporting these conversations is ongoing end of life care education for health care professionals, including communication skills training.

The outcome we should be focused on is offering a conversation regarding future care rather than measuring the number of documents completed.