Community and Hospital-based Healthcare Professionals Perceptions of Digital Advance Care Planning for Palliative and End-of-life Care: A Latent Class Analysis

Introduction: Numerous digital approaches are being explored internationally to support the elicitation, documentation and sharing of advance care planning (ACP) information. In England, Electronic Palliative Care Coordination Systems (EPaCCS) have been developed for this purpose, often as a template stored as part of an electronic clinical record system. Despite EPaCCS being central to end-of-life care policy, there has been a lack of exploration of the perspectives of healthcare professionals who use EPaCCS and are critical to their implementation. Objective: This study addresses this gap aiming to examine community and hospital-based healthcare professionals' perceptions of EPaCCS on advance care planning and the delivery of palliative care. Design and methods: A cross-sectional online survey. Setting and participants: The target sample comprised health professionals from the main professional groups supporting patients with chronic progressive illnesses in West Yorkshire and London. The survey included items adapted from the Normalisation MeAsure Development questionnaire (NoMAD) implementation measure. Survey responses were analysed using descriptive statistics and latent class analysis. Free-text responses relating to alternative approaches to advance care planning documentation were analysed using a directed content analysis approach. Results: 569 health professionals responded to the survey from West Yorkshire (n=189; 33.2%) and London (n=380; 66.8%). The largest proportion of respondents came from general practice teams (n=254; 44.6%). There were prominent differences in responses, with respondents in London more likely to report being familiar with EPaCCS. However, West Yorkshire respondents rated EPaCCS more highly in terms of being a legitimate part of their role. Across professional groups, respondents from both hospice and care home teams were more likely to view EPaCCS as being worthwhile. Commonly reported barriers to the use of EPaCCS included not having access to electronic devices, lack of training, and lack of knowledge relating to advance care plans. Limitations: There was a dominance of responses from participants based on primary care practices that may reflect general practitioners being largely responsible for initiating an EPaCCS record in one region of the survey (West Yorkshire). This survey is reliant on self-reported responses to items and may have also included respondents more engaged with or interested in EPaCCS, representing a skewed positive perspective of the systems and how they are being used in practice.