Background:Patient empowerment, defined as ‘a process through which people gain greater control over decisions and actions affecting their health’ (World Health Organization) is a key theme within global health and social care strategies. The benefits of incorporating empowerment strategies in care are well documented, but little is known about their application or impact for patients with advanced, life-limiting illness(s).Aim:To identify and synthesise the international evidence on patient empowerment for adults with advanced, life-limiting illness(s).Design:Systematic review (PROSPERO no. 46113) with critical interpretive synthesis methodology.Data sources:Five databases (MEDLINE, Embase, CINHAL, PsycINFO and Cochrane) were searched from inception to March 2018. Grey literature and reference list/citation searches of included papers were undertaken. Inclusion criteria: empirical research involving patients with advanced life-limiting illness including descriptions of, or references to, patient empowerment within the study results.Results:In all, 13 papers met inclusion criteria. Two qualitative studies explored patient empowerment as a study objective. Six papers evaluated interventions, referencing patient empowerment as an incidental outcome. The following themes were identified from the interpretive synthesis: self-identity, personalised knowledge in theory and practice, negotiating personal and healthcare relationships, acknowledgement of terminal illness, and navigating continued losses.Conclusion:There are features of empowerment, for patients with advanced life-limiting illness distinct to those of other patient groups. Greater efforts should be made to progress the empowerment of patients nearing the end of their lives. We propose that the identified themes may provide a useful starting point to guide the assessment of existing or planned services and inform future research.

The application of behavioural change tools appears sub-optimal in this group of patients. Explicit use of BCTs targeting behavioural components upon which outcomes depend may improve the uptake and effectiveness of rehabilitation interventions.

Second Conversation was felt to be of most value to newly qualified doctors and worked well on wards where length of stay was longer and EoLC conversations frequently happen. Further evaluation and exploration of patient and caregiver experiences is required.

identified 61 patients who died before being discharged to their PPC. Their clinical notes were obtained and data was collected on modifiable delays. Results Forty-seven complete sets of notes were obtained. The most significant delay was in completing and sending FT paperwork (30/47). Paperwork was not started for 3 patients and incomplete for 7 patients without explanation. Paperwork took 2-4 days to complete for 5 patients, 5-7 days for 12 patients and >8 days for 2 patients.Despite healthcare professionals identifying a patient was dying or deteriorating, a delay in decision to commence FT affected 20/47 patients. The decision to FT took 1-2 days for 3 patients, 3-4 days for 8 patients, and >8 days for 9 patients.Sudden unexpected death or deterioration was a factor in 8 patients. Family/patient indecision affected 8 patients. Delays within community services after funding was approved affected 5 patients. One patient had funding initially declined but agreed subsequently. Conclusion The most significant modifiable delays were in completing FT paperwork and in decision-making concerning FT. To reduce these delays, FT paperwork on the intranet has been reorganised, new prompts in the form of a sticker have been introduced and there is continuing education of clinical teams on decision making and FT discharge.

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Results The cause of death for the vast majority of families was accident or illness. Death of a father was experienced by 41% of CYP. Six months after the end of support, improvements were shown for the following areas: peer relationship difficulties, emotional difficulties, behavioural difficulties, overall stress and impact of difficulties on the child's life. Conclusions CYP with multiple needs who were supported through this programme experienced fewer mental health difficulties in the medium-term. Tailored psychosocial support can promote adaptive developmental outcomes after bereavement and it can be particularly helpful for CYP who face school or social adjustment difficulties.

51 were assessed as being chemically compatible after 48 hours at ambient temperatures (20-26°C). Midazolam appears to be drug at greatest risk of clinically significant chemical degradation. Microbiological stability was only reported for one combination. Conclusions There is currently limited evidence for the physical, chemical and microbiological stability of solutions for continuous subcutaneous infusion over a period of 48 hours. More stability data is required before the use of 48 hour CSCIs can be evaluated for use within clinical practice. Acknowledgements This project was funded through a grant from NHS Liverpool CCG. Background Continuous subcutaneous infusions (CSCIs) are an effective method of multiple drug administration in end of life care when the oral route is compromised. P-271,2 At present, currently available chemical and microbiological stability data limits the infusion time of a CSCI to a maximum of 24 hours.The ability to deliver prescribed medication by a continuous subcutaneous infusion (CSCI) over 48 hours may have numerous benefits in both patient care and health service resource utilisation. Aim To gather data regarding the most frequently prescribed CSCI drug combinations and the frequency at which CSCI prescriptions are altered. Design Prescription details of CSCIs containing a minimum of two drugs were collected by hospital pharmacists or members of palliative care teams at 10 Acute NHS Trusts on a daily basis for a minimum of 2 days, to a maximum of 7 days. Setting/participants Anonymised CSCI prescription data were collected from an average of 50 patients at 10 Acute NHS Trusts in the United Kingdom. Results and Conclusion Data collection is due for completion January 2017 and results will be presented. Acknowledgements This project was funded through a grant issued by NHS Liverpool CCG. Background Delirium affects up to 88% of patients with advanced cancer and is associated with significant morbidity and mortality. Despite this it remains under recognised in hospice settings and the management is not always in line with national guidelines. This research study explores the views of staff nurses and healthcare assistants in hospices in order to identify underlying reasons for this.Method Semi-structured qualitative interviews were conducted with registered nurses (12) and healthcare assistants (6) in three North-East England hospices. Data was analysed using interpretative phenomenological analysis.Results The main themes to emerge were knowledge and management. Data highlight that knowledge of delirium is variable leading to uncertainty about what constitutes delirium in hospice inpatients with subsequent difficulties in management. Subthemes in management include the emotional response evoked by caring for patients with delirium, ensuring patient safety within the hospice environment and staff perceptions about the appropriate place of care. Disparities in staff opinion are apparent between drug and non-drug approaches and there is also concern about the possible effects of me...

We report the case of an 83-year-old man who presented with a history of fluctuating delirium of insidious onset, secondary to an amoebic liver abscess more than 30 years after acute exposure. We describe a 2-year clinical journey that started with a fall and was additionally complicated by severe weight loss and acute kidney injury (AKI). The likely prognosis for such a combination of comorbidities in an older person is for lasting morbidity, institutionalisation and significant mortality. However, the case demonstrates that with timely assessment and care complete recovery is possible though it may take many months. It reminds us of the catalytic implications of falls for older persons and to maintain a differential diagnostic approach to delirium of insidious onset avoiding misdiagnosis as dementia with which it may be associated. Our case report includes extracts from the patient's own account providing added insight into such experiences.