P-91 Integration of specialist palliative care into a tertiary non-malignant service: evaluation of potential geographical disparity

Abstract

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...

Which factors influence the quality of end-of-life care in interstitial lung disease? A systematic review with narrative synthesis

“…25 These results imply a geographical disparity in access to palliative care, which has also been identified in previous work by the North East and Cumbria interstitial lung disease service. 39,40 Variability in access to specialist palliative care services is also known to be an issue for patients with other chronic respiratory diseases. 41 Referral to palliative care services is likely to be influenced by healthcare professionals' familiarity with local services and whether specialist services exist.…”

Advance care planning for patients with chronic obstructive pulmonary disease on home non-invasive ventilation: A qualitative study exploring barriers, facilitators and patients’ and healthcare professionals’ recommendations

“…The described service structure barriers to advance care planning described are not unique and have previously been reported by other tertiary regional services. 19–21 A lack of clarity and information sharing is described. Regional and local services need clear understanding of each other’s working practices.…”

“…Regional and local services need clear understanding of each other's working practices. 19,20 Agreements regarding responsibility and communication may facilitate good advance care planning and palliative care. Indicators of deterioration, such as frequent admissions, should be highlighted to regional and local teams.…”

48 The nature of complex need in specialist palliative care referrals

“…Connie Swenson, 2 John MacArtney, 3 Rachel Perry, 4 Lucy Hetherington, 5 Lisa Graham-Wisener, 6 Hazel Lamberton, 4 Emma Carduff, 7 Scott Murray, 8 Anne Finucane. 1 Background Understanding complex need as the defining characteristic of episodes requiring specialist palliative care (SPC) is key to hospice service development.…”

“…In January 2016 specialist palliative care (SPC) support was embedded in a regional IPF clinic. Initial service review (Kavanagh, 2017) suggested potential geographical disparities in access to both anti fibrotics and clinic-based SPC. Aim To repeat the 2016 review to assess whether geographical disparities have changed over time.…”