Background Non-malignant respiratory diseases (NMRD) are increasing in incidence and prevalence with figures rises with our globally ageing population. This coupled with multi-morbidity?is likely to increase the needs of individuals from a supportive and palliative care approach. The challenge within fiscally constraint health economies, is to ensure equity of care across all care settings so the individual gets care of an expected standard rather than duplication or omissions within the current services delivering the care.
Aim To explore how patients with non-malignant respiratory diseases traverse through the hospice organisation and how consistent is this approach across 3 hospice sites.
Method A retrospective case note of review of patients referred with NMRD to a hospice organisation within 1 year.
Results 169 case notes were identified with a convenient sample of 100 explored for further analysis. Length of contact varied for days to months (18) with median being 30–90 days. The majority of patients (97) had COPD, were Males (59) with median age 78 years. 63 patients had multi-morbidity (>2) with Heart Failure, IHD and Cancer being the most common. Only 60 cases had an identified carer with 50% having external professional help. Breathlessness (81) and anxiety (34) were the common presenting symptom with the vase majority of patients having a formal holistic clinical review (60), medication review (65) and attendance at a breathlessness management group (58). Opioids were commonly taken (57) along with benzodiazepines (58). Advance care planning (ACP) was attempted in the majority of cases with DNAR (63), PPOD (49) with only 15 cases explicitly reporting ceilings of care.
Conclusions Hospice care and the need for supportive and palliative care needs to dovetail with existing services and articulate clearly what and when it intends to provide input. Prognostic uncertainty, awareness and parallel planning for EOLC requires a whole systems approach.
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