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

Age Ageing. 2009 Jan;38(1):81-5. doi: 10.1093/ageing/afn235. Epub 2008 Nov 21.


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

Design: 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.

Results: 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).

Conclusion: 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.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Advance Directives* / psychology
  • Aged
  • Aged, 80 and over
  • Confidence Intervals
  • Data Collection
  • Delivery of Health Care / methods
  • Female
  • Health Services for the Aged / organization & administration*
  • Hospitals, Special
  • Humans
  • Male
  • Middle Aged
  • Patient Care Planning / organization & administration*
  • Patient Satisfaction*
  • State Medicine*
  • Surveys and Questionnaires*
  • Terminal Care
  • United Kingdom