Introduction Patients with advanced respiratory disease do not routinely access palliative care services and given that many are unable to attend hospital appointments, they are even less likely to receive quality palliative care support in their last year of life. This collaborative project between an NHS Respiratory Team and a Hospice aimed to address this inequity.
Aims The specific project aims were to: improve symptom control; raise patient and carer awareness /understanding of illness and prognosis; explore patients’ wishes about future treatment and care and establish an advance care plan (ACP); communicate patients’ wishes across health care settings; reduce inappropriate hospital admissions and inappropriate treatments.
Methods Using a convenience sample over a 12 month period, all patients who met inclusion criteria (adapted from Gold Standard Framework prognostic indicator guidance) were referred by the respiratory team to specialist palliative care (n = 49). The planned intervention comprised three visits to the patient’s home by a palliative care nurse specialist.
Data collection aimed to evaluate the outcome of visits; the follow-through of ACP wishes during hospital admissions; patient experience; GP feedback; impact of project on specialist respiratory nurses and patterns of hospital admissions.
Quantitative data was analysed using descriptive statistics and Qualitative data was collated into themes.
A favourable ethical opinion was granted for the project.
Results Results to date suggest that 1) selection criteria were effective, 2) the intervention had a positive effect on patients’ wellbeing and engagement with the ACP process, 3) purposeful communication and treatment across healthcare settings were enhanced. Some challenges are also emerging, all of which will help shape future service provision. It is anticipated that this collaborative model of service is transferrable to other non-malignant specialties and could be adapted by other hospices /palliative care servcies. Final results are due to complete by June 2013.
The project was part funded by the Burdett Trust for Nursing.
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