BackgroundIntegrating palliative care (PC) and empowering the health care workforce is essential to achieve universal access to PC services. In 2010, 46 % of patients in Mulago Hospital, Uganda had a life limiting illness, of whom 96 % had PC needs. The university/hospital specialist PC unit (Makerere/Mulago Palliative Care Unit –MPCU) implemented a link-nurse model to empower hospital nurses to provide generalist PC. Over two years, 27 link nurses were trained and mentored and 11 clinical protocols developed. The aim of the study was to evaluate the impact of the palliative care link nurse programme at Mulago HospitalMethodsAn evaluation approach utilising mixed methods was used integrating qualitative and quantitative data including: pre and post course assessment confidence ratings; course evaluation forms; audit of clinical guidelines availability; review of link-nurse activity sheets/action plans; review of MPCU patient documentation; Most Significant Change (MSC); individual and focus group interviews.ResultsA significant difference was seen in nurses’ confidence after the training (p < 0.001). From July 2012 to December 2013, link nurses identified 2447 patients needing PC, of whom they cared for 2113 (86 %) and referred 334 (14 %) to MPCU. Clinical guidelines/protocols were utilised in 50 % of wards. Main themes identified include: change in attitude; developing new skills and knowledge; change in relationships; improved outcomes of care, along with the challenges that they experienced in integrating PC. Since the start of the programme there has been an increase in PC patients seen at the hospital (611 in 2011 to 1788 in 2013).ConclusionThe link-nurse programme is a practical model for integrating PC into generalist services. Recommendations have been made for ongoing development and expansion of the programme as an effective health systems strengthening approach in similar healthcare contexts, as well as the improvement in medical and nursing education.

Background In order for palliative care to be provided to all in need, an integrated approach to service delivery is needed, where a mixture of specialist and generalist care is provided. A needs assessment in 2010 showed 40% of patients in Mulago hospital have palliative care needs. Thus the Makerere Palliative Care Unit (MPCU) developed a programme to train link-nurses across the hospital supported by a referral pathway and identification process. Aims To integrate palliative care into all wards of Mulago Hospital through a link-nurse programme. Methods 27 link nurses from 11 clinical areas, were trained and mentored over the past 2 years. An evaluation of the programme was carried out using quantitative and qualitative data collection methods including; pre and post course confidence ratings; course evaluation forms; review of link-nurse activity sheets and action plans; review of MPCU patient documentation; Most Significant Change (MSC); and focus group discussions (FGDs).

Background Chronic obstructive pulmonary disease (COPD) is a disease of the lungs that is characterised by a consistent airflow obstruction. It is associated with persistent, progressive and irreversible breathlessness. COPD remains the fifth most common cause of death in England and Wales, accounting for about 25 000 deaths a year. Despite this, only 30% of patients with COPD have had a discussion about palliative care with their clinician. When conversations do take place, they usually happen during a hospital admission when patients are very unwell and are unable to fully express their preferences, and with clinicians who do not know the patients. Furthermore, recent research has shown that clinicians do not know when and how to start and conduct conversations with COPD patients. Aim To explore COPD patients' preferences for the timing and nature of palliative care conversations with healthcare professionals. Methods Interviews and case-note review of COPD patients. Patients were recruited into 3 different groups according to their disease severity: mild, moderate and severe. A total of 33 patients were recruited into the study and the topics discussed during the interviews included: understanding about COPD and palliative care, care preferences and preferences for palliative and advance care planning discussions with doctors and nurses. Patients were recruited from GP practices and respiratory outpatients' clinics in the south of England from April to September 2017. The methodology for data analysis encompasses interpretative phenomenology analysis. Results Preliminary themes of the study include: healthcare professional discussing palliative care; timing for palliative care discussions; approaches to discuss palliative care; patients' understanding about COPD; patients' understanding about palliative care; patients' care preferences. Conclusion Greater understanding of patients' preferences and understanding of palliative care and end of life conversations will be discussed.

. Oncology patients from Outpatient areas . Radiotherapy treatment areas . Oak Road Treatment Centre. . Community Macmillan direct referrals A bespoke proforma was completed after each consultation by the treating clinician. 413 ambulatory patient reviews took place over a 6 month period. An in depth analysis has been conducted of 236 new patient referrals between January and June 2017. Overall results show a significant impact on patient outcomes, with 21% avoided admissions, 25% facilitated early discharge and 43% avoided escalation of symptoms/GP review.Data analysis remains on going to assess readmission statistics; in particular an analysis of early OAU discharges, facilitated by the ESC clinic review of low risk neutropenic patients.The service currently operates two clinics a week on Monday and Thursday afternoons. A business case has been submitted proposing service expansion to operate daily clinics.As the first cancer centre to implement this service, we have welcomed oncology teams from other centres across the UK, enhancing practice elsewhere.