Palliative care must change, grow and mature in response to the growing number and complexity of needs of community patients. Such demands particularly challenge conventional delivery of day hospice. In response our hospice redesigned day service provision to modernise bespoke day facilities, appoint a day hospice sister and introduce several novel clinical interventions. Patient outcome measures were introduced and research projects undertaken.The aim of the study was to evaluate whether extended day hospice services could address more patient needs. Newly developed services were introduced in the period April 2015 – May 2016. Management and clinical key performance indicators were obtained for this period and compared with annual data from the previous year. Two facilitated focus groups were undertaken with the multidisciplinary team and with the management team to better understand the service developments and participant’s aspirations for day services.It was found that introducing five additional patient services – Blood transfusion clinic; Progressive Supranuclear Palsy support group; Motor Neurone Disease clinic; Multi System Atrophy support group and a Carers’ support group – led to a 27% increase in attendances. Staff, patients and their families were recruited to three research projects by three hospice staff as a core part of their role, and five staff contributed to qualitative studies or data collection. The qualitative data indicated that staff were pioneering the new well-coordinated services but were challenged by the time available to capture data. The management team had a vision for further expansion of sustainable services and innovative approaches of working in partnership with the local acute trust and community care providers.In conclusion, a diversification of day services offered to patients and carers can be facilitated with engaged managerial and professional staff without a significant increase in core workforce.

Background Patients with bone metastases can suffer from considerable pain and reduced quality of life, in addition to complications such as pathological fracture and spinal cord compression. Bisphosphonates can be used as an adjunct to treat pain in addition to conventional analgesia and radiotherapy. Aims Our outpatient bisphosphonate infusion service at the hospice was set up in 2008, in conjunction with our local acute NHS trust oncology unit. The pilot service initially accepted patients with bone metastases from hormone refractory prostate cancer when pain was not controlled with conventional radiotherapy and analgesia. Method Patients benefit from an outpatient appointment with a doctor and nurse to assess current symptoms using IPOS (Integrated Palliative care Outcome Scale), followed by bisphosphonate treatment on the same day. Referral into other services within the hospice, such as physiotherapy, occupational therapy, rehab services and our FAB (Fatigue, Anxiety and Breathlessness) clinic, can be made when needed. Results Following review of the service we now accept patients earlier in their disease trajectory and treat patients with bone involvement from other diagnoses such as myeloma, sarcoma or renal cancer. Our referral numbers continue to increase on a yearly basis.We have successfully treated patients with recurrent hypercalcaemia in the day case setting by monitoring levels closely and treating early with a bisphosphonate before they are symptomatic; thereby reducing morbidity, preventing the need for inpatient admission and reducing pressure on acute hospital services. Conclusion Future expansion of this interventional outpatient clinic might include breast cancer patients who currently receive denosumab injections in the hospital. We could use this model of service to allow early integration of these patients into palliative care services and allow them to benefit from the diversity of therapies and services the hospice can offer at an earlier stage in their illness.

Background Ascites, a palliative symptom, is the build-up of large volumes of fluid in the peritoneal cavity which is drained at around five litres. If an indwelling catheter isn't possible then living with large volumes of fluid which are intermittently drained, is very uncomfortable. Earlier research showed that an abdominal support garment improved discomfort and provided support to their large distended abdomens (Preston 2004). However, the garment was too warm and also 'rode up' making it difficult to wear especially in warmer weather. Aim To assess the acceptability of a support garment for use with people with ascites. Methods Five prototypes for a support garment using a range of materials to offer abdominal support were developed with the company Jobskin. The ongoing study with eight participants with ascites (alcohol related liver disease and malignancy) will assess wear-ability and support requirements including an assessment of comfort, ease of putting on/off, mobility and acceptability. The garment, shaped like cycling shorts, can be made in a range of sizes and colours. Results A garment was developed using five sections offering different types of pressurised support including a main abdominal area which allows for support but can significantly increase to allow for abdominal growth. The support garment supported an increase in abdominal girth from 70 cm to 110 cm in the initial participant yet remained comfortable. Early results have had it described as 'invaluable' by one doctor at the end of life of a patient to help her get in and out of bed when drainage was no longer an option. Interpretation and conclusions A support garment has been created which can allow for increased abdominal girth yet provide abdominal support. Early indications show it is very acceptable, improves discomfort and offers the support required.