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Age and Ageing Advance Access originally published online on November 21, 2008
Age and Ageing 2009 38(1):81-85; doi:10.1093/ageing/afn235
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© The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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

Rebekah Schiff1, Rory Shaw2, Nadia Raja3, Chakravarthi Rajkumar4 and Christopher J. Bulpitt5

1 Department of Ageing and Health, Consultant Physician, St Thomas’ Hospital, London SE1 7EH, UK
2 Medical Director, Hammersmith Hospitals NHS Trust, London W12 ONN, UK
3 Specialist Registrar, Hammersmith Hospitals NHS Trust, London W12 ONN, UK
4 Professor of Geriatrics and Stroke Medicine, Brighton & Sussex Medical School, Royal Sussex County Hospital, Brighton BN2 5BE, UK
5 Emeritus Professor of Geriatric and Cardiovascular Medicine, Care of the Elderly, Imperial College, Hammersmith Hospital, London W12 ONN, UK

Address correspondence to: Dr R. Schiff, Department of Ageing and Health, Consultant Physician, 9th Floor, North Wing, St Thomas’ Hospital, London SE1 7EH, UK. Tel: 020 7188 2086; Fax: 020 7928 2339. Email: rebekah.schiff{at}gstt.nhs.uk

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.

Keywords: elderly, advance care planning, Mental Capacity Act, end-of-life care

Received 1 August 2007; accepted in revised form 3 July 2008.


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