Background: Enhanced supportive care (ESC) promotes the earlier implementation of supportive care within cancer care. While earlier supportive care has been demonstrated to improve patient outcomes, the model of delivery is variable. The Clatterbridge Cancer Centre has developed a multi-professional delivered model with clinical nurse specialists providing ongoing patient review and care. Method: A retrospective single-system design was used to assess longitudinal changes in Integrated Palliative Care Outcome Scale (IPOS) scores as indicators of quality of life. For other outcomes, a retrospective case control analysis was undertaken. Results: Statistically significant improvements in all IPOS scores were observed for patients attending ESC. Compared to controls, quantitative outcomes included prolonged survival and reduced chemotherapy-related mortality. Multi-professional delivered ESC successfully improves quality of life and outcomes.

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Aims and objectives Compare 3 month survival of patients with metastatic cancer admitted to hospice and hospital. Methods All adults known to have metastatic cancer preadmission to district general hospital or hospice over a 2 month period were included. Parameters compared: proportions discharged and died; length of in-patient stay; mean survival; survival at 3 months. Results Total number of patients -106 (hospital:72; hospice:34). 60% of hospital group women; 65% of hospice men. Hospice patients were significantly younger, mean age -69.09 vs 75.36 years; p-value 0.006. There was no difference in baseline investigation (FBC; renal and liver functions; serum calcium) results of two groups. There was no difference in proportion of patients discharged (57% hospital vs 59% hospice); proportion dying during admission (43% hospital vs 41% hospice); mean or median length of in-patient stay (hospital vs hospice, mean days: 13.29 vs 14.26, median -9.5 vs 9.5); and mean survival (22 days) in 2 groups. Forty four percent of hospital patients were alive at 3 months, versus 35% of hospice -but insignificant difference (p-value: 0.121). There was no correlation between age and survival (r=À0.10; p-value: 0.941). Conclusions This small study demonstrates no survival benefit of invasive (district general) hospital approach against holistic hospice approach in patients with metastatic cancer. Hospital clinicians should not be concerned that hospice approach would shorten survival of their patients and lengthen hospital stay. All clinicians and managers should be aware that a third of hospice patients survive more than 3 months and that there are mechanisms to identify and manage them promptly.

Conclusions Death cafes proved to be an effective tool for staff development and increased healthcare professionals' confidence in discussing death. We will now expand this through using a similar format as an educational tool with medical students. The sessions will focus on training in end of life care; the process will be evaluated in terms of design and learning gain. The results will be available for the conference. Background Death and the process of dying is an inevitable part of the practice of medicine. The ability to provide palliative care is a necessity for every junior doctor and currently approximately 60% of deaths occur in hospital. It has been suggested that current undergraduate medical education is failing to prepare junior doctors for their role in caring for dying patients. Dealing with death and talking to distressed relatives is also a major source of stress. This study aims to explore and describe the type and amount of undergraduate palliative medicine education received; to explore and describe the participant's level of confidence towards the management of patients with palliative care needs and to assess the level of prescribing knowledge when faced with common palliative care scenarios. Methods Mixed methods questionnaires including case vignettes with single-best answer, multiple choice questions were completed under exam conditions by newly qualified junior doctors. Results 37 FY1 doctors were included in the study. The mean time allocated to undergraduate teaching was 21 hours with a wide range of 2-140 hours. A palliative clinical placement was a component of teaching in 41% of participants. Participantreported confidence levels varied among the four areas explored but the majority of participants responded negatively. The mean score of the knowledge component of the questionnaire was 45% (range 20%-80%). Level of participantreported confidence demonstrated no correlation with knowledge as assessed. Conclusions This study highlights the lack of exposure of undergraduates to patients with palliative care needs, a variable level of knowledge when faced with scenarios they are likely to encounter during foundation years, and a level of confidence in the subject which may not correlate with their practical abilities. Introduction Opioids are commonly prescribed by Junior Doctors in the acute hospital setting. Here we describe the selfreported behaviour of this professional group in relation to opioid prescribing for palliative in-patients at a District General Hospital. Method A structured survey was completed by twenty-seven training grade doctors from F1-CT3 (85.2% F1 or F2). The anonymous responses related to self-reported behaviour based on recall of patient care episodes. Results Two thirds of respondents were involved in the care of palliative patients on a weekly basis. Therefore, the prescribing of opioids and evaluation of treatment efficacy should be embedded into their practice. 15 VARIANCE IN SELF-REPORTED OPIOID PRESCRIBING PRACTICES BY JUNIOR DOCTORS AT A DISTRICT GENER...

BackgroundWhen performed inappropriately cardiopulmonary resuscitation (CPR) can prevent those with irreversible illness having a peaceful death. In people approaching the end of life, making decisions about whether to attempt CPR is integral to good care.AimAudit clinical practice around CPR decision–making and communication with patient‘s, those important to them and other healthcare professionals (HCPs) against regional standards.Use audit outcomes to update regional standards and guidelines.MethodsSystematic literature review examining education for HCPs, communication with patients and those important to them and dissemination of decisionsSurvey of HCPs working in specialist palliative careMulti–centre retrospective case note review of patients with a do not attempt cardiopulmonary resuscitation (DNACPR) decision receiving specialist palliative care in hospital, hospice or community settings. Results73 HCP’s participated in the survey and 87% had discussions about CPR. In HCPs having conversations about CPR 75% rated their confidence in doing so as 8/10 or higher.187 case notes were reviewed. While DNACPR forms indicated whether the decision had been discussed with the patient in 87% only 72% had a record of this in the written notes. 68% of case notes had a record of discussions or reasons for non-discussion with those important to the patient.34% of patients moved care setting after the DNACPR decision, of these 64% transferred with a unified DNACPR form.ConclusionThis audit shows ongoing challenges in communicating with patients and those important to them about CPR. Improvement is required in disseminating DNACPR decisions when patients transfer care settings.