Participants described the transition period as a difficult time for both the YP and their families, with a perceived lack of adult services available for them. All groups agreed that the pilot project had a positive impact on the YP and their families, with the social benefits highlighted as a key factor. All participants were keen for the project to continue, ideally on a more frequent basis with more overnight stays, and the parents were keen to be more involved in the running of the service. Conclusion The key stakeholders in this service were all positive regarding the impact the service has had on the YP and their families, and were keen to see it continue. This pilot models a service that could be adopted by other organisations. A patient's preferred place of death (PPD) is frequently used as a marker for quality of end of life care. However, surveys of patients with life-limiting conditions indicate that "dying in preferred place" is not their highest priority (Actions for End of Life Care NHSE 2014-2016. As end of life approaches other priorities often take precedence and PPD may change. Aim of our audit To establish how many inpatients referred to our hospital Supportive and Palliative Care Team (SPCT) had PPD recorded, what their preferences were and whether they changed. Methods Data was extracted retrospectively from a database of inpatient deaths referred to the SPCT between July and August 2016 Results 63 patients had a PPD recorded -33 patients at initial consultation and 30 patients at subsequent consultation. Initial PPD was acute hospital (25), home (16), no preference (9), hospice (9), care home (4).13 patients (21%) changed their PPD during their admission. 6 patients with initial PPD home or hospice changed to acute hospital. 4 people changed their preference to care home (from hospice or home). From 16 patients whose initial PPD was home, this remained their final preference in 7 cases. 6 patients changed their PPD more than once. Conclusions Our data shows that almost half of patients do not discuss PPD at initial consultation but are happy to state preferences subsequently. This could be due to development of rapport and relationship with SPCT members. Interestingly, PPD changed during the hospital admission in one fifth of cases with the majority electing to not spend last days of life at home. This could be due to changes in condition, symptoms and performance status coupled with perceived burden on caregivers. Discussing preferences for place of death should be a dynamic process as care related priorities may change as end of life approaches. Background A scoping exercise and literature review of national and local initiatives highlighted innovation and evaluation as critical elements of change within the healthcare system, where NHS policies require healthcare professionals to research effective ways to deliver healthcare, including evaluation and service improvement. Gaps were identified through reflection in and on practice, within a dyspnoea clinic in a palliative care setting. Th...

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BackgroundAn Acute Oncology Service (AOS) is paramount to providing timely and improved pathways of care for patients who are admitted to hospital with cancer-related problems or suspected cancer.ObjectiveTo establish an AOS pilot study to decide how best to implement such a service locally.MethodsThe AOS, which included collaboration between the oncology and palliative care teams at the Northern General Hospital in Sheffield, UK, ensured that the majority of oncology patients in the region received timely assessment by an oncologist if they became acutely unwell as a result of their cancer or its treatment. The AOS consisted of a thrice-weekly ward round, and daily telephone advice service.ResultsWe report on patient data during the first 12 months of the pilot study. Delivery of the AOS enhanced communication between the services and provided inter-professional education and support, resulting in earlier oncological team involvement in the management of patients with cancer admitted under other teams, as well as provision of advice to patients and their caregivers and families. Provision of the AOS shortened the mean length of hospital stay by 6 days. Two case studies are presented to illustrate the typical challenges faced when managing these patients.ConclusionsEstablishment of the AOS enabled effective collaboration between the oncology and other clinical teams to provide a rapid and streamlined referral pathway of patients to the AOS. Locally, this process has been supported by the development of acute oncology protocols, which are now in use across the local cancer network.Journal of Comorbidity 2012;2:10–17

Background Methadone is a synthetic opioid used in refractory pain. There is increased awareness of methadone related adverse events including respiratory depression and QTc prolongation. In our region several methods exist for methadone initiation, falling into two categories: switching one opioid to methadone (stop and go -SAG) and adding methadone to another opioid (addition -ADD). Aims To characterise how methadone is being used locally. To quantify the nature and frequency of methadone induced side effects. Methods All patients prescribed methadone by the palliative care teams in Sheffield and Chesterfield over an eight month period were included. Data were prospectively collected on diagnoses, indication(s) for methadone, method of conversion, ECG recording, pain scores and side effects. Results 25 patients were prescribed methadone, all as inpatients. 20 patients had malignancy, the remainder chronic pain. Methadone was chosen in all cases due to persistent pain and/or medication side effects. A SAG method was used for 72% and ADD for 28%. The median daily oral morphine equivalent dose prior to initiation was 240 mg (range 50 mg -1000 mg). 92% had an ECG prior to commencing methadone.Following titration, the median methadone dose was 10 mg BD (range 4 mg -40 mg BD). Average pain scores reduced from 7/10 to 3/10 in both groups.28% reported side effects of sedation, nausea, confusion or hallucinations. 2 patients required naloxone and 3 developed QTc prolongation, all in the SAG group.72% were discharged home, 8% were transferred to another hospital and 20% died. None of the deaths were attributable to methadone. Conclusion Locally, methadone is prescribed for patients with chronic pain as well as those with malignancy. Methadone results in clinically meaningful pain relief regardless of method of initiation. A SAG method is used most frequently. All five clinically significant adverse events were reported in the SAG group.

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