Advance end-of-life healthcare planning in an acute NHS hospital setting; development and evaluation of the Expression of Healthcare Preferences (EHP) document

Abstract

Objective: design and evaluate a document to enable older inpatients in an NHS hospital to discuss and record end-of-life healthcare preferences. Design: user and professional collaboration to design the Expression of Healthcare Preferences (EHP). Prospective questionnaire survey and outcome evaluation. Setting and Participants: inpatients on wards for older adults in a London NHS Hospital Trust. Results: the EHP consists of a form and explanatory booklet. 95 patients (mean age 81, median MMSE 28) received the EHP. 61 (64% (54–74%)) read the EHP and 29 (48% (35–61%)) of these recorded their healthcare preferences in the EHP form. The form prompted end-of-life care discussions between 43% (30–57%) of these patients and medical staff and between 52 (38–65) of these patients and “those close to them”. The EHP was highly rated: on a score of 1 to 10 it was thought to be helpful (median score 8), interesting (8), informative (8) and reassuring (7) but not upsetting (1). Conclusion: the EHP is an end-of-life advance healthcare planning tool that we have shown can be used to prompt older inpatients to discuss and record their end-of-life healthcare preferences.