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Views and Practices of Anaesthetists Towards End of Life Decisions and Advance Care Planning

Blackwood, Douglas Hector; (2021) Views and Practices of Anaesthetists Towards End of Life Decisions and Advance Care Planning. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Despite low mortality rates, ~2%, the high volume of surgery now conducted in the UK means that around 100,000 people die each year within 90 days of having an operation. It is probable that these patients would have benefited from a discussion about their wishes and preferences prior to the operation via a process of advance care planning. Pre-operative assessment clinics, commonly operated by anaesthetists, offer an opportunity for this prior to surgery. Aim: This thesis aims to describe the most important components of end-of-life and advance care planning discussions as well as barriers which may prevent anaesthetists from engaging in these conversations pre-operatively. Methods: A mixed methods study was carried out to outline the knowledge, attitudes, and practices of UK anaesthetists towards end-of-life decisions and advance care planning in the perioperative setting. This involved multiple workstreams: two systematic reviews; two national surveys of UK anaesthetists; and a qualitative component involving semi-structured interviews and participant observation. Results: UK anaesthetists were found to be knowledgeable and have a good understanding of advance care planning. They have positive attitudes towards the concept both generally and perioperatively, and strongly support the principle of autonomy. When considering their own end-of-life care the themes which emerged were: ‘patient engagement’; ‘intensity of treatment’; ‘family and friends’; a ‘transition point’; ‘care’; and plans for ‘after death’. Perioperative advance care planning was not a routine part of anaesthetists’ practice as the treatment limitations implied were not felt to align with surgical care. The structure and organisation of pre-operative care also creates barriers to anaesthetists having these discussions. Conclusion: This study has demonstrated that advance care planning is not a routine part of UK anaesthetists’ practice for patient’s approaching surgery and outlines particular attitudinal and practical barriers. It describes a process for a modified advance care planning discussion appropriate for surgical patients.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Views and Practices of Anaesthetists Towards End of Life Decisions and Advance Care Planning
Event: UCL (University College London
Language: English
Additional information: Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
URI: https://discovery.ucl.ac.uk/id/eprint/10126799
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