Does Having an Individualized End-of-Life Care Record Actually Make a Difference?

Area of Science:

• Palliative Care
• Clinical Auditing
• Healthcare Quality Improvement

Background:

• The National Institute for Health and Care Excellence (NICE) advocates for individualized end-of-life care (EOLC), emphasizing personalized care records.
• Individualized care records aim to facilitate shared decision-making and the rationalization of non-beneficial treatments and monitoring.

Purpose of the Study:

• To evaluate the effectiveness of an individualized record of care in supporting end-of-life care at a UK tertiary cancer center.
• To assess the impact on clinical decision-making and the rationalization of observations and medications.

Main Methods:

• A clinical audit of 98 patient case notes from May 2024 was conducted.
• Data on clinical decision-making and treatment rationalization were collected and analyzed.
• Outcomes were compared between patients with and without an individualized care record.

Main Results:

• Patients with an individualized care record showed significantly higher rates of observation rationalization (97.3% vs. 75%) and medication rationalization (74.3% vs. 41.7%) (p < 0.01).
• Certain medications, like prophylactic low molecular weight heparin (LMWH), were less frequently rationalized.
• Discussions regarding rationalization were documented in about half of cases, often occurring post-decision.

Conclusions:

• The implementation of an individualized end-of-life care record enhances the review and rationalization of patient observations and medications.
• Further qualitative research is necessary to understand barriers to shared decision-making and rationalization discussions in EOLC.