Background Early introduction of palliative care improves outcomes in advanced non-cancer diseases (Davis, Temel, Balboni, et al. Ann Palliat Med. 2015;4(3):99–121). At our tertiary centre patients undergo potentially curative high-risk treatments where clinical uncertainty is rife. Successful integration of specialist palliative care (SPC) within some teams indicated this service could be expanded to address the needs of patients in other areas.

Aim To conduct a triangulated needs assessment of SPC provision at Harefield Hospital (HH) to identify strengths and priority areas for future service development.

Methods The steering group of clinicians and patient representatives oversaw the project. There were three arms to the triangulated approach (Higginson, Hart, Koffman, et al. J Pain Symptom Manage. 2007;33(5):500–5). The epidemiological arm analysed routinely collected data. The corporate arm sought views of staff, patients and carers through questionnaires and focus groups. Colleagues from heart and lung transplant centres in the UK were interviewed and literature searches conducted for the comparative arm.

Results This is an ongoing project. Initial results indicate that most referrals to SPC were for inpatients, almost half of which were from the intensive care unit, mostly for family support. An established local pathway for early integration of palliative care in the lung transplant assessment process accounted for 20% of referrals. Symptom management was a common reason for referral. Referrals for decision support were uncommon despite most clinicians welcoming SPC support directly for patients and/or through participation in multi-disciplinary team meetings. Only one other UK centre provides a similar model to that at HH. Whilst international guidelines support early involvement of SPC across a range of cardiothoracic diseases (McDonagh, Metra, Adamo, et al. Eur Heart J. 2021;42(36):3599–726; Saeed, Feldman, Banayosy, et al. J Heart Lung Transplant. 2023;42(7): e1-e222; Bradley, Branley, Egan, et al. Thorax. 2008;63 Suppl 5:v1–58) this guidance is not being fully implemented in practice.

Conclusions There is unmet need for specialist palliative care at HH, specifically for early integration of palliative care in situations of high symptom burden, complex decision making and prognostic uncertainty. Priority areas for service development will be shared at the conference.