End-of-Life Escalation Planning in Advanced Cancer Audit

This project audits whether escalation planning for adults with advanced cancer is clinically clear, person-centred, documented, reviewed and communicated across care settings. It reviews recognition of advanced disease and changing goals of care, treatment intent, oncology and specialist palliative care input, escalation limits, CPR and emergency care recommendations, potentially reversible complications, symptom and anticipatory planning, capacity and best-interests documentation, discussion with the person and those important to them, and whether plans are visible at the point of care and communicated at handover, discharge, transfer, community, hospice, care-home, ambulance and out-of-hours interfaces.

• Oncology, haematology and specialist palliative care teams, including cancer nurse specialists
• Acute medicine, emergency department, ward and critical care outreach teams
• GP practice, community, hospice and care-home clinical teams
• Pharmacists where medicines and anticipatory prescribing are locally reviewed
• QI leads, governance and patient safety teams, supervisors and educators

• Measure documentation of advanced cancer status, treatment intent and changing goals of care
• Assess escalation limits, CPR and emergency care planning, and consideration of reversible complications
• Review palliative care input, symptom control and anticipatory planning documentation
• Test capacity, best-interests, discussion and family communication documentation
• Measure review, visibility and transfer-of-care communication, and generate governance-ready and ARCP-ready evidence

• Anonymous case identifier
• Inclusion / eligibility decision
• Anonymised context (age band, sex/gender recorded, care setting, escalation context, optional cancer group)
• Clinical area / location and optional specialty / service
• Twenty-seven escalation-planning criteria (met / not met / not applicable)
• Free-text learning points and any project custom fields

• Live dashboard
• Audit report (Word)
• Executive summary (Word)
• Excel workbook
• PowerPoint presentation
• Conference poster
• ARCP evidence summary

This ready-built project is developed using the guidance, standards and authoritative sources listed below, so you can see what is being measured and why. Lazomis QI does not publish or own this guidance, and inclusion here does not imply endorsement or approval by any of these organisations.

• NICE

  NG142: End of life care for adults — service delivery(opens the original source in a new tab)

  National guideline on identifying people approaching the end of life and coordinating their care.

• NICE

  NG31: Care of dying adults in the last days of life(opens the original source in a new tab)

  National guideline covering recognition, communication, shared decision-making and anticipatory prescribing.

• NICE

  QS13 and QS144: End of life care quality standards(opens the original source in a new tab)

  Quality standards on identification, individualised care planning, coordination, communication and review.

• NICE

  NG108: Decision-making and mental capacity(opens the original source in a new tab)

  National guideline on capacity assessment, supported decision-making and best-interests process.

• NICE

  NG197: Shared decision making(opens the original source in a new tab)

  National guideline on involving people in decisions about their care and recording those discussions.

• GMC

  Treatment and care towards the end of life: good practice in decision making(opens the original source in a new tab)

  Professional guidance on end-of-life decision making, capacity, CPR decisions and communication.

• Resuscitation Council UK / BMA / RCN

  Decisions relating to CPR and the ReSPECT process(opens the original source in a new tab)

  Suggested source requiring user review — confirm whether ReSPECT or a local emergency care and treatment plan is adopted locally.

• Legislation / local policy

  Mental Capacity Act 2005 and Code of Practice(opens the original source in a new tab)

  Statutory framework for capacity assessment and best-interests decision-making; apply alongside local MCA policy.

• Designed to use anonymised or pseudonymised audit identifiers.
• This tool supports, but does not replace, clinical judgement.
• Local policy, formulary and specialist advice should be followed.
• Organisations remain responsible for local governance arrangements.
• This tool supports documentation and escalation-planning quality assurance only. It does not provide patient-specific oncology advice, palliative treatment advice, CPR decisions, emergency treatment recommendations, prognosis estimates, capacity decisions or best-interests decisions.
• Prognosis thresholds, ceilings of care, critical care criteria, DNACPR decisions, ReSPECT categories, palliative referral triggers, symptom-control regimens, anticipatory medicines and transfer routes are locally configured and are not presented here as national standards.
• Use anonymous case identifiers only — never patient-identifiable information, and never identifiable detail about family members, attorneys, deputies, carers, clinicians, care homes or hospices.

Supporting guidance from the Lazomis QI Resource Library. Authoritative clinical standards referenced by this project remain separate.

• Patient SafetyEscalation Failures: Understanding and Preventing Harm in Clinical PracticeEscalation failures are a significant contributor to avoidable harm in healthcare. This guide explores their root causes and outlines practical steps for NHS staff to improve communication, clinical handover, and timely senior review.
• Clinical GovernanceIntegrating Quality Improvement into Clinical Governance FrameworksThis article explores the vital relationship between Quality Improvement (QI) and Clinical Governance within the NHS, demonstrating how they are two sides of the same coin when aiming for continuous, systematic improvement in patient care.
• Clinical GovernanceLeveraging Incident Themes for Quality Improvement and Patient SafetyThis guide helps NHS teams identify and analyse recurring incident themes, transforming reported safety events into practical quality improvement opportunities to enhance patient safety and system reliability.
• Patient SafetyReducing Handover Failures for Safer Patient CareEffective clinical handover is critical for patient safety, yet failures remain a significant contributor to adverse events. This guide explores the common pitfalls and offers practical, evidence-based strategies to improve handover processes across healthcare settings.