EC4H Realistic Conversations: Using REDMAP in Treatment Escalation Planning (TEP) Conversations

A free webinar for NHS Greater Glasgow and Clyde staff involved in TEP discussions.  This online session allows participants to watch a real time interactive demonstration led by EC4H tutors.  Participants will have the opportunity throughout the demonstration to contribute suggestions and feedback to the tutor team via the chat box.

Workshop overview

Brian Clark, 72, was admitted yesterday with uncontrolled pain and delirium. He is a widower who lives alone in his own home. Brian was diagnosed with prostate cancer 6 months ago and is on hormone therapy for progressive bone disease. He has poor pain control despite multiple analgesics. No anticipatory care plan in the KIS and no DNACPR form. He is due to have radiotherapy planning but is too acutely unwell. Senior doctor on duty to phone Brian’s son/daughter (Douglas/Diane Clark) with information about Brian’s clinical situation and to discuss his care plan after the ward round.

This session will demonstrate:

Treatment Escalation Plans“A Treatment Escalation Plan (TEP) is a communication tool which is helpful in hospital when a person with serious illness has the potential for acute deterioration or may be coming towards the end of their life. Sometimes doing everything possible may actually lead to harm – to more suffering and distress rather than less – and without any particular gain. What can be done and what should be done may not necessarily be the same thing. Treatment Escalation Plans should be discussed and made based on personalised realistic goals rather than ‘one size fits all’ treatment.

Crucially, a TEP provides on-call hospital staff with immediately accessible guidance about how to respond to an individual in times of crisis, especially out of hours and at weekends. A TEP becomes particularly important when there is agreement that interventions or referrals for more intensive care that are contrary to a person’s wishes or are futile or burdensome should not be undertaken. Equally in many patients who may have an agreed DNACPR, a TEP clarifies all the treatments and care that should continue.”

In severe illness quality of care becomes more important than ever but the goals of treatment are different for different people. Hospital care is becoming more and more complex and both patients and their families are particularly vulnerable to the impact of errors, harms and poor communication. It is especially important for hospital staff to understand and respect the values and preferences of the people they are looking after and to discuss with them a plan for emergencies.

Knowing how the plans should be sensitively discussed and used is important and this session provides a framework for such conversation

Learning outcomes

Workshop participants will:

Review their current practice in communication about treatment related decision-making and consent

Working together, they will practice more effective ways to:

• Communicate information about risk clearly and effectively with a wide range of patients and families.
• Communicate the benefits and limitations of treatment in a balanced way.
• Manage patients and families who have unrealistic expectations of treatment and outcomes.
• Use decision aids to support effective communication and complex shared decision-making
• Respond to complaints about clinical decision-making and consent