Background Earlier referral to palliative care is increasingly being utilised in solid tumour oncology to improve quality of life and symptom control. Patients with haematological malignancies have similar symptom burden but are frequently referred later to palliative care. We recently established an integrated early palliative care service for patients with recently progressive or relapsed myeloma within our tertiary referral cancer centre. Patients are seen within the haemato-oncology clinic by a member of the palliative care team.
Methods We evaluated this new service using a quality improvement PDSA (Plan, Do, Study, Act) framework under domains of proportion of eligible patients reviewed, evidence of patient needs and staff feedback. Demographic details including age were collected from electronic patient records, MyPOS (Myeloma Palliative Outcome Scale), performance status and disease stage. Anonymous feedback was collected from haematology professionals working in the clinic using an online questionnaire.
Results Multiple PDSA cycles were completed over 5 months. These generated changes including seeing patients during their haematology review, and patients completing MyPOS assessments on arrival. 58% (25) of eligible patients were reviewed, improving from 43% at the project’s start to 86% at its end. 89% of patients reported at least one severe symptom, and 67% reported at least one overwhelming symptom. Despite this, patients had a median Karnofsky Performance Score of 80. Feedback from haematology professionals reflected a desire for increased co-working and palliative care presence within the department, including 90% rating the value of the service for patients as very positive.
Conclusion Early palliative care in myeloma is feasible and allows input for patients not routinely referred to palliative care, potentially enabling shared decision making, advance care planning and improved quality of life. Patients have a significant symptom burden that may benefit from symptom control input.
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