Implementing and assessing the acceptability of a portable, readily accessible, and actionable end of life planning tool for patients with advanced serious illness or frailty in southern New Zealand

Abstract

The Clinical Order Articulating Scope of Treatment (COAST) form was designed as a single-page medical order documenting and communicating the resuscitation status and scope of appropriate medical treatment for adult patients believed to be in their final year of life. Prior to introducing COAST, each health provider or agency in the Southland region of New Zealand had its own forms and processes; the COAST pilot attempted to consolidate and streamline these varied processes into one actionable medical order that is valid throughout the region. This three-phase initiative involved piloting use of the COAST form in Southland between May 2019 and January 2020. Surveys were given to patients at the time of COAST form completion and distributed electronically to health professionals at the end of each phase to assess attitudes towards COAST form use and obtain feedback. The hypothesis was that COAST would be acceptable to patients, families, and health providers. The response rates for patient and health professional COAST experience surveys were low (24% and 27% respectively) but the feedback was positive, with the majority of respondents expressing that the COAST form improved patient care. Implementation of the COAST form has been widely accepted by patients, families, and health professionals alike.