Introduction Patients are often referred to palliative care at a stage when they are rapidly deteriorating and prognosis is short, meaning they receive a reactive service and have limited opportunity to benefit. The term ‘palliative care’ and its association with death for both professionals and patients, deters earlier referral to and engagement with the service. Palliative care can improve symptom control, quality of life and ensure patients‘ priorities and preferences are met. It can impact on interactions with other health care services.
Methods We developed a new service for all patients diagnosed with incurable upper gastro-intestinal cancers, delivering a proactive palliative care style of patient centred care earlier. This was delivered as the Enhanced Supportive Care (ESC) CQUIN. The ESC service was outpatient based and consultant led. Patients were identified through MDTs and rapidly offered assessment. Follow-up depended on needs. The IPOS questionnaire supported needs assessment. Patients were referred to other services as needed. Information was collected and comparison of outcomes made to data for a comparable period the preceding year.
Results Patients offered ESC or palliative care review at diagnosis increased (43%-93%)
The service was acceptable to most (85% accepted)
Symptom burden was high - 82% had at least one severe/overwhelming symptom at diagnosis
On follow-up, average severity score of 11/13 symptoms had improved
Average length of hospital stay in the last 30 days of life fell, equating to a saving of 220 bed days or £88000/year
Patient/relative feedback was very positive.
Discussion The data suggests ESC is acceptable to and benefits patients. Fixed term funding is enabling the service to be expanded short term. Robust data collection and service analysis continue.
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