Background With few systematic attempts to demonstrate the impact of day-to-day palliative care in clinical services, this study aimed to demonstrate the impact of inpatient palliative care by using routinely-collected outcomes data to estimate the prevalence of symptoms/concerns, and demonstrate improvement in these outcomes over episodes of care.
Methods Secondary analysis of routinely-collected clinical and outcomes data (patients demographics, episodes of care, palliative Phase of Illness, and symptoms/concerns using the Integrated Palliative care Outcome Scale; IPOS) from all admissions to one inpatient hospice unit, between June – November 2019. We defined ‘improvement in outcome’ as any patient with ‘moderate’, ‘severe’, or ‘overwhelming’ IPOS items (scored 2,3 or 4) at start of episode of care, which improved to ‘not at all’ or ‘slightly’ (scored 0,1) by end of episode. Caldicott Guardian approval was received for analysis of this anonymized data.
Results 20,999 contact observations relating to 386 patients receiving 417 episodes of care were analysed. This incorporated 2,307 palliative Phases. Median age was 73 years (IQR 60–83); 82% had cancer.
By the end of the episode of care:
Mean ‘pain’ score changed from 1.9 to 1.2, with 47% of the 125 patients with pain improved
Mean ‘breathlessness’ score improved from 1.1 to 0.8, with 48% of the 64 patients with breathlessness improved
Mean ‘anxiety’ score changed from 1.9 to 1.3, with 42% of the 73 patients with anxiety improved
Mean ‘feeling depressed’ score changed from 1.5 to 1.0, with 52% of the 56 patients with depressed mood improved
Mean ‘information needs’ score changed from 1.2 to 0.9, with 78% of the 36 patients wanting more information improved.
Conclusions For the first time in UK, an inpatient hospice has systematically used routinely-collected outcomes date to demonstrate the marked positive impact of the clinical care provided.
Funding Supported by Yorkshire Cancer Research (L412)
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