Advance end-of-life healthcare planning in an acute NHS hospital setting; development and evaluation of the Expression of Healthcare Preferences (EHP) document.
OBJECTIVE
design and evaluate a document to enable older inpatients in an NHS hospital to discuss and record end-of-life healthcare preferences.


METHODS
user and professional collaboration to design the Expression of Healthcare Preferences (EHP). Prospective questionnaire survey and outcome evaluation.


METHODS
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).


CONCLUSIONS
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.
Schiff
Rebekah
R
Department of Ageing and Health, St Thomas' Hospital, London SE1 7EH, UK. rebekah.schiff@gstt.nhs.uk
Shaw
Rory
R
Raja
Nadia
N
Rajkumar
Chakravarthi
C
Bulpitt
Christopher J
CJ
D016223:Advance Directives / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003625:Data Collection; D003695:Delivery of Health Care / Q000379:methods; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration*; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning / Q000458:organization & administration*; D017060:Patient Satisfaction; D013222:State Medicine; D011795:Surveys and Questionnaires; D013727:Terminal Care; D006113:United Kingdom