P-219 The earlier the better: early referral to palliative care improves quality of life

Abstract

BackgroundIn 2014 the WHO declared that ‘early palliative care not only improves quality of life for patients but also reduces unnecessary hospitalisation and use of health care services’. Following an audit in 2014 the Contact Centre at our hospice were aware that there were a number of patients who would benefit from our services but were either declining the services or being declined due to not being able to meet the criteria for specialist palliative care and end of life care.AimsTo develop an early palliative care service which allowed the patients and families/carers to experience a modern hospice approach of living well and palliative reablement. This included:· Advance care planning· Early support for families and carers· Networking with other agencies e.g., CAB, carers support· Live well approach· Opportunity for referral to hospice services to prevent crisis e.g., 24 hour advice line, H@H· Psychological support.Methods· Outpatient style appointment at an Outreach Centre close to home at the patient’s/family convenience with a named nurse.· Patient centred approach· Referral to other internal and services· Flexible approach to use of hospice services.Results· Significant increase in the number of patients/families gaining access to hospice services· Extension of lighter touch services· Increase in referrals of non-cancer and long term conditions· Positive feedback from patients/families· Earlier referral for some patients to complex specialist services· Development of the nursing team’s skill mix· De-stigmatises hospice care.Conclusion· Further investment in the early referral services as patients and families/carers are utilising living well and palliative reablement services· An opportunity to encourage end of life conversations and advance care planning for patients with dementia· Potential to extend into GP surgeries/satellite clinics to reduce anxiety around being referred to a hospice· Potential to extend into outpatient services at local hospitals to support patients who are newly diagnosed as palliative.

Concerns and potential improvements in end-of-life care from the perspectives of older patients and informal caregivers: a scoping review

“…Another enhancer of patient satisfaction with EOL care is earlier referral to palliative care consultation. A retrospective study [ 74 ] and a prospective pilot outreach outpatient close to the patient’s home have shown reduction in aggressive healthcare interventions and improved quality EOL experience [ 75 ]. While these studies are encouraging, higher-level evidence is required.…”

How healthcare providers’ own death anxiety influences their communication with patients in end-of-life care: A thematic analysis

“…Lily (R-DAS 59) -I still feel like a lot of [whether I avoid the conversation] comes down to whether the doctors have discussed it fully with the patient ... especially when you're planning the patients end-of-life, they want to hear it from the doctor. They don't want to hear it from [an occupational therapist] Diane, a nurse, described delaying discussing advance care as long as possible, based on a doctor's assessment of the patients' prognosis:Diane (R-DAS 52) -we don't tend to discuss their wishes with them until the doctor has actually said this person doesn't have long left … before that you're thinking well obviously we hope this won't be needed as they will be able to go home Diane's apparently reactive approach could sacrifice the potential benefits of earlier advance care planning, which enables more time for discussion, multi-disciplinary team involvement, or referral to palliative care(Eskins et al, 2017). Diane's approach may reflect lack of training, for only one participant (Amanda) reported receiving any training in completing an Advance Decision to Refuse Treatment (ADRT), and only one of the doctors (Joseph) reported ever seeing ADRT documentation.…”