A report published today (Friday 31st August 2018) has revealed that Ambulance Trusts across the UK vary significantly in their policies and practices regarding advance care planning documentation. This could result in ambulance crews not being aware of, and therefore failing to respect, a patient’s stated preferences for medical treatment and care.
Findings from a Freedom of Information request conducted by Compassion in Dying highlight a lack of a unified system for recording and implementing advance care plans, and a widespread absence of systems for monitoring and analysing adherence to advance care plans. Compassion in Dying is now appealing to Trusts and paramedics to implement the report’s recommendations to ensure that the end-of-life wishes of people in their area are known and followed.
Compassion in Dying was prompted to conduct this research after receiving frequent enquiries from people who are concerned about whether their advance care plans will be respected in an emergency situation or when being transported between care settings. Such plans can include an Advance Decision (to Refuse Treatment – often known as ‘Living Will’), a Do Not Attempt Cardiopulmonary Resuscitation (DNAR) form, and/or a Lasting Power of Attorney (LPA) for Health and Welfare.
Key findings include:
· 23% of Trusts (3 of 13) have no systems at all for holding advance care plans for patients in their areas. The remaining Trusts vary significantly over whether they simply record the existence of plans, keep physical or electronic copies of them, or have access to systems used by GPs which include information about advance care plans.
· There is a diverse approach among Trusts regarding who they will accept advance care plans from, and in what form. 46% of Trusts (6 of 13) accept them from individuals, whereas 31% (4 of 13) will only do so from healthcare professionals. 15% of (2 of 13) Trusts require original documents to be seen and one Trust will only accept their own version of an Advance Decision form.
· 85% of Trusts (11 of 13) were unable to report on the number of advance care plans adhered to in 2017.
Compassion in Dying has also found that confusion over policy can cause distress not only to individuals and their loved ones but also to the paramedics treating them, according to previous research:
“At the age of 96, my mother had a severe aneurysm and the paramedics wanted to take her to hospital to have a stent fitted. She was adamant she was not going into hospital and I respected these wishes… I explained about her Advance Decision, which they knew nothing about. Halfway to hospital, having finally read the relevant document they had subsequently been given, they changed their minds and palliative care was put in place.”
– Christine Erskine
“As a paramedic it is immensely frustrating and upsetting when things aren’t put in place allowing us to leave someone at home where they wish to be. I was not prepared for the heartache of having to take a dying patient away from their home and into general hospital.” – Donna Main-Clancy
Davina Hehir, Director of Policy at Compassion in Dying said:
“We recognise that ambulance crews work in time-pressured and stressful environments. However, if person-centred care is to become a reality, it is crucial that Ambulance Trusts consider how systems for respecting end-of-life wishes can be strengthened and improved – for the benefit of patients, their loved ones and paramedics alike.
“We propose a number of recommendations on improving policies, systems and training strategies. Most importantly, we want to open up conversations with Ambulance Trusts and paramedics about what support they feel they need in order to achieve these objectives and what initiatives are already in place that can be replicated elsewhere. We want to help ensure that everyone gets the end-of-life care that’s right for them, and that ambulance crews are fully supported to play their part in achieving this.”