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

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design and evaluate a document to enable older inpatients in an NHS hospital to discuss and record end-of-life healthcare preferences.


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.


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).


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.

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