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P-20 Thinking ahead clinic – equitable palliative care for liver disease patients
  1. Sarah Myford
  1. Keech Hospice Care, Luton, Bedfordshire


In early 2019 Keech Hospice Care was contacted by the consultant hepatologist at the local hospital who was concerned that liver patients were experiencing inequality of access to palliative care services. Due to the complexity of these patients they have high hospital attendances/admissions (over 70% of patients with advanced liver disease die in hospital), which could be prevented with increased shared care between the acute hospital and the hospice.

Two nurse practitioners from the hospice started working with the consultant hepatologist and commenced ‘thinking ahead clinics’. A nurse practitioner joins the consultant in the hospital outpatient clinic to introduce hospice care, patients would then be invited to the hospice’s nurse-led liver clinic.

The ‘thinking ahead’ clinic was initiated to talk about advance care planning, ensure the patient has access to all hospice services such as community support emotionally and physically; social work for help with finances, housing and will writing; carers support; talking therapies for emotional support; access to venepuncture, infusions and palliative doctor reviews, along with the rehabilitation team which facilitates keeping palliative patients well for as long as possible and our inpatient unit for symptom control or end-of-life care.

The community specialist teams accept referrals when there is complex physical or psychological needs. Until this time liver patients have limited access to services and support. By attending liver clinics we can ensure they have access to the right care throughout their illness so that plans are made before a crisis hits. This includes referring and working with community nursing teams, GPs, hospitals, the homeless and drug and alcohol services.

The work we have been doing together, and the achievements are fantastic… an excellent example of what we can achieve by working together. I am very happy to know our patients have a better quality of life with our joint input’ (Hepatology team: Acute hospital).

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