Planning for Future Care With Patients With Advanced Cancer: Examining the Feasibility of Using the Trajectory Touchpoint Technique for Advance Care Planning.

1.1 BACKGROUND In 2014, academics at the University of Liverpool Management School who are service quality researchers were approached by East Cheshire Hospice (ECH). ECH provides specialist palliative care for people with progressive life-limiting illnesses, providing services to patients, carers and families via inpatient and outpatient units and day facilities. ECH strives for excellence in service and the patient experience. Anecdotal stories and other forms of feedback provided plenty of evidence that the work of the hospice was meaningful. However, ECH did not have any systematic, robust way of capturing these experiences. Hence, while ECH was often told it had transformed the experience of patient's at the most critical time in their lives and that it was needed and appreciated by many service users, there was nothing but anecdotal evidence to back up this feedback. Worried that such superb feedback could actually lead to complacency, the team at ECH commissioned the University to undertake a 'deep-dive' of the impact of hospice services upon the different inpatient and outpatient service users associated with ECH.

The team, comprising Prof Philippa Hunter-Jones and Dr. Lynn Sudbury-Riley, designed a new qualitative research technique to follow the user's experience at every touchpoint in their journey. In 2015, interviews with 38 in-patients, outpatients, visitors and bereaved families enabled a 'deep-dive' to uncover perceptions of the whole service experience among these diverse users. Results of this new approach suggested the technique fully captures the hospice experience and suggests areas for improvements to hospice services. Indeed, the results of the study have informed the strategy and operations of ECH, and, mindful of continuous improvement, ECH have requested that the exercise is repeated.

Other hospices heard of the success of this work and the team were commissioned by Oakhaven Hospice in Hampshire to work with them, too. Additionally, based on the success of the project, the project was shortlisted by the school for a REF impact case, and the team were awarded funding to repeat the project in further hospice and palliative care settings.

The Academic Palliative Care Unit on 4Y at RLBUHT was one of the palliative care units to be evaluated next. From the service evaluation project on 4Y grew the novel idea to use the TTT as part of the Advanced Care Planning (ACP) conversation lead by clinicians. ACP is not consistently carried out for all patients that might have a need. There is also not a consistent way in which ACP is conducted to ensure quality is maintained within the patient centric approach.

1.2 RATIONALE FOR CURRENT STUDY Advance Care Planning (ACP) is the process of making choices and plans in regards of future care for patients with life limiting disease, particularly those who may lose the capacity to communicate. ACP has been shown to positively impact on the quality of end-of-life care, yet few (only 6-8%) have a completed formal ACP: a result of patients' anxieties about discussing future care issues and clinicians' concerns over responsibility and starting a "difficult" conversation.