The COAST project: Introducing and implementing a transferable, readily accessible, and actionable end of life planning tool for patients with advanced serious illness or frailty in southern New Zealand.

THE FORM This project is designed to enhance and streamline processes already in place. There will be no attempt to influence the discussions between patients/proxies and clinicians, or to influence the clinical decision making. The intervention is simply the consolidation of multiple variable processes into one portable and universally acceptable medical order, with the hope of reducing incongruent medical interventions. It is up to the treating doctor/nurse practitioner to decide when it is appropriate to have the discussion and complete the form. It should take no longer than 30 minutes to have the discussion and complete the COAST form. There are five sections of the form to complete: 1. Resuscitation Status 2. Medical Interventions There are three options of care: i. Full Treatment. ii. Selective Treatment. iii. Comfort-focused Treatment. 3. Fluid and Nutrition 4. Additional Orders The section can be used for psychosocial, spiritual, or cultural considerations. 5. Clinical Decision Making This section records the date of discussion with the patient/proxy and the signature of the relevant doctor or NP. The treating doctor or NP should complete and sign the COAST form. In most cases, this will be the GP. However, any doctor or NP who encounters an eligible patient should complete and sign the COAST form if it has not already been done. The COAST form does not have an expiration date. COAST form should be reviewed periodically and updated as appropriate if there is a significant change in an individual’s health status, or the individual’s treatment preferences change PILOT TIMELINE Implemented in 3 phases: Phase 1 (3 months): Southland Hospital, Hospice Southland, Palliative Care Advisory Service. Phase 2 (3 months): Expand to GPs and ARC facilities in Invercargill. Phase 3 (3 months): Expand to Southland region. This is not a randomised control trial. Any patient who meets the inclusion criteria and consents to the research will be included. Only patients presenting to health facilities/residing in ARC facilities in the Southland region will be included, as per each phase. DATA COLLECTION Copy of completed forms will be received by study co-ordinators at both Southland Hospital and Hospice Southland sites. An audit of the forms will be completed at the end of each implementation phase to determine whether they are valid (patient identified, all applicable fields completed, form signed and dated by the doctor/NP). Participants will be asked to complete a survey after the COAST form has been completed. With consent, the study co-ordinators will then access the patient’s electronic health record. Patient demographics of all patients recruited will be recorded in a database to assess if the study population is representative of the population of southern New Zealand. Patient demographics will include age, gender, ethnicity, principal diagnosis, place and type of residence, and the encounter setting for discussion and completion of COAST. Part 1 of data collection will involve retrospective audit to assess number of emergency department presentations and hospitalisations in the 12 months preceding study enrolment. Part 2 of data collection will involve assessing number of emergency department presentations, hospitalisations, COAST form revocations and/or revisions, and care environment transitions for 12 months after study enrolment. Place and cause of death, if applicable, will be recorded.