The supportive care plan: a tool to improve communication in end-of-life care.

The End of Life Care Strategy (Department of Health, 2008a) states that acute hospitals need mechanisms in place to ensure that people who are approaching the end of life have their needs assessed, their wishes and preferences discussed, and an agreed set of actions reflecting these choices recorded in a care plan. The Supportive Care Plan was designed to encourage discussion of patients' preferences for end-of-life care, and to provide a tool for recording those preferences and communicating them to other healthcare professionals. Initial analysis of the results of a pre- and post-implementation audit of patient notes suggests that there has been an improvement in the documentation about preferred place of care and patient and family understanding of the illness. Fifty per cent of patients who died with a Supportive Care Plan in place died in their first choice of place of care and 22% in their second choice. Feedback from patients and relatives was positive. The main barriers to implementation were difficulties for staff in prognostication, especially for patients with a non-cancer diagnosis, and a reluctance from staff to initiate discussions that were perceived to be too time-consuming. There were also concerns about dealing with the emotions that such a discussion may generate in both patients and relatives.