72 Advance care planning: staff perceptions of patients rights, choices and preferences

Background Advance care planning (ACP) is a process of formal decision making and documentation for future reference. For this to be communicated effectively nuances such as the difference between; ‘Choice’, ‘Preference’ and ‘Rights’ are paramount for decision making and understanding. This communication need has to be present on both sides of the consultation table. Aim To explore the perception and understanding of the terms; ‘Choice’, Preference’ and ‘Rights’ of the palliative care multidisciplinary team in relation to aspects of ACP. Methodology An electronic survey completed by clinical staff within Severn Hospice over a week period. Results There were 32 respondents from 8 different job roles. 69% (22) stated ‘place of death’ as a ‘Preference’ with 28% (9) stating it a ‘Choice’. Exploring ‘DNACPR’ demonstrated; ‘Choice’ 39% (12)/‘Preference’ 29% (8)/‘Right’ 35% (11). Decisions regarding ‘refusing care’ were mostly seen as a ‘Right’ (62% n=20) whereas ‘requesting aspects of care’ such as admission and medications were perceived as ‘Choice’ (40% n=13) or ‘Preference’ (37% n=12). The qualitative aspect asked for perceived definitions of ‘Choice’, ‘Preference’ and ‘Rights’ of which we split into multiple themes. ‘Choice’ had a predominance of the themes of ‘options’ and ‘information’. ‘Preference’ had predominant themes of ‘options’ and ‘if possible’. Rights had a more legal focus/aspect. Conclusion There’s considerable heterogeneity in the understanding of the terms; ‘Choice’, Preference’, and ‘Rights’, and even more so between the terms ‘Choice’ and ‘Preference’. Given this is conducted upon hospice staff this gives a measure for concern as potentially conflicting messages and understanding could be communicated.