Background For patients who present with advanced pancreatic cancer, prognosis is poor irrespective of treatment. Good end of life care is therefore essential.
Aim To examine specific elements of care given to patients at a tertiary hepatobiliary centre, to inform service improvement.
Method The Hepatobiliary MDT identified 78 patients presenting with advanced pancreatic cancer who died between July and December 2010. Data was drawn from hospital and hospice notes using a proforma.
Results Mean survival time from diagnosis was 6.6 months. 59% had jaundice, 67% of whom underwent biliary drainage procedures. The majority required repeated attempts, prolonging admission and sometimes precluding a patient from dying elsewhere. 65% were referred to hospital palliative care teams, most commonly for symptom control; pain being predominant. There was evidence of limited advance care planning. Prognosis was discussed with 55%. No patients had an Advance Decision to Refuse Treatment or Advance Statement of wishes documented in their notes. 24% died in local acute hospitals. Of these, preferred place of death (PPD) was discussed with 32%, of whom 50% indicated it was home. PPD was only discussed following palliative care team involvement. DNA-CPR forms were completed for all patients except one, who had a sudden, unexpected death. 47% died on the Liverpool Care Pathway (LCP). 12% died in the hospice. PPD was discussed with all except one confused patient for whom it was considered with the family. In all hospice deaths, the PPD was the hospice. All had DNA-CPR forms completed, and 8 of 9 patients utilised the LCP.
Conclusion Although biliary drainage may improve symptom control, these patients needed complicated procedures, often prolonging hospital admission at a time when they were deteriorating. Despite opportunities for discussion of end of life preferences during these admissions, there was evidence of little advance care planning for hospital inpatients.
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