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Can the Palliative Care Outcome Scale be used to measure the positive impact of a hospital based palliative care liaison team?
  1. Jane Whitehurst1,
  2. Katherine Michaels2,
  3. Nicola Montacute2,
  4. Sue Williams2,
  5. Brenda Ward3 and
  6. Janet Gillett3
  1. 1 Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
  2. 2 Taunton and Somerset NHS Foundation Trust, UK
  3. 3 St Margarets Hospice, Somerset, UK

    Abstract

    Background The Palliative Care Outcome Scale (POS) is a holistic, validated, Patient Reported Outcome Measure (PROM). PROMs can enable evaluation of patient care, helping to improve service quality.

    Aims To assess POS as a tool for patient assessment and clinical audit in a nurse-led hospital liaison palliative care team (HPCT).

    Methods We used POS and POS-S (symptoms) at initial, weekly and last consultations in 30 patients and evaluated the HPCT experience of this.

    We used the following Minimal Clinically Important Difference in scores to determine PCT effectiveness

    80% percent achieving a one-point reduction in pain score

    Statistically significant reductions in grouped POS and POS-S scores (Wilcoxon signed rank test)

    Results The HPCT saw 57 patients to collect 30 patients' data. (23 clinically unsuitable, 4 missed). Follow-up questionnaires were available in 19 patients for POS, 15 for POS-S (7 patients seen once, 1 data set destroyed, remainder missed).

    A one-point reduction in pain score occurred in 74% patients (14 out of 19 with follow-up POS data).

    Both POS and POS-S median scores improved. POS median score: initial consultation 17, last consultation 6 (p=0.002) POS-S median score: initial consultation 17, last consultation 8.5 (p=0.04).

    ▸ The HPCT felt that POS was useful to:

    • Establish the patient's agenda

    • Enable early discussion of psychosocial concerns

    • Reduce the risk of missing significant needs

    Concerns were:

    • The staff time required to complete POS

    • That patients found repeated questionnaires burdensome

    That POS data may underestimate HPCT effectiveness as sometimes advice was disregarded and patients were discharged before a final assessment

    Conclusions The HPCT significantly improved patient well-being. However, repeat use of POS was burdensome and low inclusion and follow-up rates suggest POS is not a suitable audit tool to measure our HPCT effectiveness at this time. Using POS and POS-S at the initial consultation usefully established the patients' baseline status and needs. The HPCT will continue to use it in this manner.

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