An investigation of the natural history of decision making around treatment escalation in seriously unwell patients: A retrospective case note review

Theme 6

Complexity at End of Life

The research team from are undertaking a small scale but in-depth analysis of 45 sets of patient medical records (case notes) from individuals who died in 2015. The purpose of this is to gain detailed understanding of how decisions about treatment and care, are made by the healthcare professionals in negotiation with patients and/or their families, as the patient’s health deteriorates and they approach the end of life.

The study will build on audit work carried out in one NHS hospital Trust to gain wider understanding of decision-making processes, communication and documentation at times of clinical deterioration. It is hoped that this understanding will aid healthcare professionals in the future implementation of treatment escalations plans (TEPs). TEPs offer frameworks on which to base conversations, with patients and their families, and document treatment options that are appropriate if an individual were to become seriously unwell. The case note review is part of our wider programme of work to develop, implement and evaluate TEPs in the Wessex region.

The study has been approved by a NHS Research Ethics Committee and authorised via the Confidentiality Advisory Group at the Health Research Authority (under section 251 of the NHS Act) whereby case notes may be accessed without consent if the information to be gained is in the public interest, through medical research. There are rigorous confidentiality procedures in place and any published information will be entirely non-identifiable.
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Dr Michelle Myall

Dr Tom Monks

Marion Penn

Professor Alison Richardson

Professor Carl May


University of Southampton

University Hospital Southampton NHS Foundation Trust