Feasibility of a Prognostication Aid to Promote Advance Care Planning.

Shuler, Andrew (2025) Feasibility of a Prognostication Aid to Promote Advance Care Planning. Masters thesis, University of Wales Trinity Saint David.

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Abstract

Background: Advance care planning is a process which supports individuals in anticipating future care needs and being able to contribute to those decisions. By identifying those more likely to deteriorate, and require healthcare support, they can be empowered by having their preferences recognised. An improved patient experience will provide less moral distress, better communication and more efficient use of resources. However, the interface between palliative care and digital insights has had very limited consideration. Aim: The aim of this study was to explore the feasibility of identifying a cohort where promoting advance care planning is more timely. The existing wealth of digital data provides the opportunity to explore how this can provide such a prompt. Methods: A prevalent cohort study was carried out to ground the relevance of this research focus. The inpatients on a census day were followed for 12 months to identify the likelihood of death. The second aspect was a qualitative phenomenological study using semi-structured interviews as to the perceived feasibility of a prognostication aid. Six interviews took place in person. The in-depth perspectives were then thematically analysed. Results: The quantitative study identified that 19.3% of the cohort population died within six months of the census date. There was an increasing correlation between age and dying within six months. 13.0% of the cohort who were 60-64 years of age died within the following six months (odds ratio 18.41; p<0.0001); compared to 28.4% of the cohort who were 85 years of age or older. (odds ratio 4.79; p<0.0001); Themes that arose from the semi-structured interviews were: i) its utility, ii) uncertainty of prognostication, iii) capacity of clinician, and, iv) ethical considerations. The concept of prognostication to support advance care planning was positively received. Concerns focused on medicine being an art rather than an algorithm and whether clinicians had the time and skills to fulfil the intent of this proposal. There was also a recurrent focus on the topical Assisted Dying Bill. Conclusion: The in-depth perspectives supported the feasibility of a digital prognostication aid to aid the promotion of advance care planning. Further qualitative studies could engage with a larger group, including patients, to appreciate the breadth of opinions. These would be necessary to inform appropriate change management with application of any such prognostication aid.

Item Type:	Thesis (Masters)
Subjects:	R Medicine > RA Public aspects of medicine
Divisions:	Theses and Dissertations > Masters Dissertations
Depositing User:	Victoria Hankinson
Date Deposited:	09 Jul 2025 13:53
Last Modified:	09 Jul 2025 13:53
URI:	https://repository.uwtsd.ac.uk/id/eprint/3797

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