78 Advance care planning in hospital in the last year of life: where are we now?

Background Advance care planning allows individuals with a life-limiting illness to plan ahead with their preferred wishes for treatment and care towards the end of life. Many patients in the last year of life are likely to experience an unplanned hospital admission. It is recommended hospital healthcare professionals should feel equipped in their roles to implement advance care planning. However, significantly low numbers of patients have a documented advance care plan. Aim The aim was to explore the experiences of hospital healthcare professionals when delivering advance care planning with patients in the last year of life. Methods Systematic synthesis of qualitative literature. Four databases were searched for primary research studies written in English language between 2013 to present. The search yielded 671 articles for screening. Studies were excluded if they included specialist palliative care practitioners and if advance care planning was experienced early in a disease trajectory. Results Six articles were identified, critically appraised and used for data extraction and synthesis. These studies were synthesised using meta-aggregation and the following themes were established: 1) There are important communication considerations when effectively delivering advance care planning in hospital. The process of information sharing plays a fundamental role in communication. 2) Both professional and organisational barriers exist in hospital-based advance care planning which are compounded by the medicalised approach of hospital admissions and perceived differences between the professions involved. 3) Hospital healthcare professionals express feelings of uncertainty but are less likely to discuss or utilise other emotional responses. Conclusion This literature review reveals there continues to be barriers that hinder how hospital healthcare professionals, not working in palliative care, experience involvement in advance care planning with patients at the end of life. It is suggested further research focuses on validated and effective models of education and that implementation of advance care planning is approached inter-professionally.