O-15 Making end of life planning accessible – evaluating talking mats to support advance care planning with people living with neurological conditions

Background

People with neurological conditions can find it difficult to communicate effectively through speech, and some have cognitive difficulties that make it challenging to process complex issues. A range of resources are available for developing Advance Care Plans (Healthcare Improvement Scotland. Anticipatory care planning toolkit; What Matters Conversations. What matters most charter; Planning ahead tool – hosted on Hospice UK website). Many of these require literacy and an ability to talk about and consider emotive issues through words. Talking Mats is a visual communication tool that can support these conversations in an accessible way (Stans, Dalemans, de Witte, et al.Tech. Disab. 2019; 30(4):153–76).

Aim

To find out to how the ‘Thinking ahead’ Talking Mats resource can be used to support people with neurological conditions to have conversations about future plans.

Methods

We trained 18 people to use Talking Mats through a foundation session, then a face-to-face simulation day using the ‘Thinking ahead’ resource. Sessions were planned with people with neurological conditions, and covered issues they prioritised. Participants were asked to have three Talking Mats conversations and provide feedback. They were invited to attend a focus group exploring the barriers and facilitators to using Talking Mats. Care Measures (Mercer, McConnachie, Maxwell, et al. Fam Pract. 2005;22(3):328–34) were completed after each session.

Results

To date, 26 reflections have been returned. Care Measure results show high levels of engagement and involvement. Talking Mats (card or digital) has enabled people to see what they need to do in relation to planning ahead. Though emotional, this is useful and powerful. Barriers include professional gatekeeping around who should have these conversations (e.g. care and treatment). Further work is needed to explore the best ways to introduce Talking Mats.

Conclusions

Initial feedback suggests that people with neurological conditions benefitted from using Talking Mats to plan ahead. Training is required to ensure professionals can use Talking Mats and hand over control to the person and their family.