Title: The SHIPS study: SHaring Information at the Primary/Secondary care interface for patients with a poor prognosis
Funder: Department of Health and Social Care

Abstract: Background Emergency admissions in the last year of life are costly to the NHS, often unnecessary, and can be traumatic for patients and their families. A significant proportion of people die in the 12 months following an admission. Hospital admission is, therefore, a unique opportunity for hospital clinicians to identify patients with a poor prognosis (probably in the last year of life) and share this with General Practitioners (GPs) at discharge. This can lead to improved continuity of care, providing a trigger for the GP to initiate Advance Care Planning (ACP) discussions with patients and their family/carers. This has the potential to reduce avoidable admissions to hospital and increase the likelihood of patients dying in their preferred place. Aim To investigate the communication of poor prognosis from secondary care to primary care at the point of hospital discharge. Research questions What processes are currently in use in the UK for identifying those hospital inpatients with a poor prognosis for communication to primary care on discharge? What are the clinical and demographic differences between patients with a poor prognosis who have this information shared with their GP at discharge and those patients for whom this communication does not occur? What mechanisms are used in UK hospitals for communicating poor prognosis to GPs at the time of hospital discharge? What impact do these mechanisms have on future care? What information do GPs need following hospital discharge, for patients with a poor prognosis, and in what format? Methods The SHaring Information at the Primary/Secondary care interface for patients with a poor prognosis (SHIPS) study will be conducted in two phases: Phase one I will conduct a systematic review and narrative synthesis of interventions used to share information about patients with a poor prognosis between secondary care and primary care at discharge from hospital. This will review and synthesise qualitative, quantitative and mixed-methods research evidence. The outputs will be used to refine the plans for the next phase. Phase two A qualitative exploration of the communication of poor prognosis to primary care on discharge will be undertaken using ethnographic methods. I will spend time on hospital wards across four hospital trusts, making detailed observations of interactions between clinicians and between clinicians and patients. I will also interview patients, hospital clinicians and GPs about their views and experiences of sharing and/or receiving this information. Timelines Five year study, beginning 01/10/2020. Anticipated impact Following discharge, patients who are probably at the end of life will experience improved continuity of care and will be given the opportunity to have ACP conversations. GPs will feel more confident in the identification of patients for initiation of ACP conversations, focusing on patients who have a poor prognosis. Hospital clinicians will understand the information GPs need when they discharge patients with a poor prognosis, enabling improvements in this information sharing. Greater continuity of care, resulting in fewer emergency admissions in the last year of life.Dissemination Dissemination will include open-access journal publications, linked blogs, conference presentations, and a position paper.

Lay abstract: Aim of the research The aim of this research is to understand what information, about patients who are probably coming towards the end of their lives, should be shared with General Practitioners (GPs) after a hospital stay, and how it might best be shared. Background to the research GPs find it challenging to identify patients who are coming towards the end of their lives. My previous research has found that GPs would welcome clear communication from hospital specialists concerning those patients for whom the end of life is probably approaching. Identification of these patients while in hospital, and communication of this information to their GP when they return to home, enables continuity and coordination of care. Advance care planning discussions can then enable patients' wishes to be identified and respected, including their preferences for place of care and death, and future admission avoidance. Design and methods At present little is known about what information should be shared, about patients who are probably approaching the end of their lives, by hospitals with GPs and how it might best be shared. The SHaring Information at the Primary/Secondary care interface for patients with a poor prognosis (SHIPS) study will look into this in two ways: I will search the literature for the different ways that hospitals share this information, and whether these methods make a difference to patient care. Findings will be used to guide part two. To understand what helps or hinders this communication, I will spend time on a range of hospital wards across four hospitals, making detailed observations of interactions between clinicians and between clinicians and patients. I will also interview patients, hospital clinicians and GPs about their views and experiences of sharing and/or receiving this information.Patient and Public Involvement (PPI) This research has been developed at two workshops with the Bristol Palliative and End of Life Care PPI Advisory Panel. The panel felt strongly that patients should be involved in the sharing of information, between clinicians, about them and their care. The interviews with patients will ensure that the views and experiences of patients are central to the study findings. We will continue working closely with members of the panel, which will meet fifteen times during the five-year study, to: oversee the study, review/edit patient-facing materials, assist with the analysis of data, and write a patient-facing publication of study findings.Panel members will be provided with training, support, travel expenses, and vouchers acknowledging their contribution, and have the opportunity to help share the research findings through presentations and publications. Dissemination As well as publishing results in academic journals and conferences I will use blogs and social media to reach a wider audience. My research team has strong links to NIHR Applied Research Collaborations (ARCs), Clinical Commissioning Groups, and the West of England Academic Health Sciences Network (WEAHSN), allowing me to share my findings with practising doctors for the benefit of patients and public.

Research activity codes: 7.2 END OF LIFE CARE;7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE