Background In the UK, chronic obstructive pulmonary disease (COPD) affects 1 in 5 people and is the third leading cause of death in England (Public Health England. UK NSC recommendation on adult screening for Chronic Obstructive Pulmonary Disease (COPD). 2018). COPD caused, on average, 28,600 deaths per year in the UK between 2007 and 2016 (HSE. Work-related chronic obstructive pulmonary disease (COPD) in Great Britain. 2018). National guidelines recommend palliative care support for those with advanced, non-malignant respiratory disease. However, despite experiencing significant symptom burden these individuals often experience poorer access to specialist palliative care services than those with cancer. Clear eligibility criteria and the use of a patient pathway for those with COPD respiratory disease improves patient access to palliative care, improves coordination and patient experience (Boland, Owen, Ainscough, et al. BMJ Support Palliat Care. 2014; 4(2):196–201).

Aims

1. Develop clearer referral criteria and pathways for patients with non–cancer respiratory disease referred to the hospice.

2. Effectively test and implement a patient pathway for those with non–cancer respiratory disease that allows improved access to community specialist palliative care support.

Methods Communication and engagement with external stakeholders to agree referral criteria and service offer for the hospice community team which supports non cancer respiratory patients. Carried out a baseline staff survey to establish their experience of working with non - cancer respiratory patients. Carried out a patient experience survey and used insight from this to inform the design of a patient pathway. Piloted a patient pathway, carried out an audit of staff compliance, measured appropriateness of referrals for non-cancer respiratory patients.

Results With stakeholder involvement, developed a patient pathway to support the patient journey. 83% of referrals received were appropriate during the pilot phase. Staff reported clearer referral criteria and the patient pathway helped ensure referrals received were appropriate and helped clinical decision making.

Conclusions Findings from this project informed the development of a palliative patient pathway. Work to understand the impact of intervention for patients is ongoing.