Introduction The aim of palliative care is to achieve best quality of life possible for terminally ill patients, through holistic assessment and appropriate, timely management of problems where progressive advanced disease is unresponsive to curative treatment. Terminally ill patients form a significant proportion of the acute medical take. Could this warrant extension of palliative care services in the community? Is poor discussion of patients' wishes regarding treatment and end of life care leading to unnecessary hospital admissions?
Aims and Objectives The aim was to identify the nature and extent of palliative care services available to patients with terminal respiratory disease, both in the community and hospital setting. We also determined if patients' preferences regarding long-term care had been addressed.
Methodology This was a retrospective study within the Ulster Hospital. Data was collected for deceased patients on the respiratory ward between January and April 2011. These patients were diagnosed with a progressive, incurable disease with a life expectancy <1 year. We identified: inpatient specialist palliative involvement, respiratory team palliative care, preceding community respiratory or palliative team input, preadmission discussions regarding severity of disease and point of care.
Results Eleven patients with terminal respiratory disease died on the ward. 54.6% received community palliative team review preadmission. 100% received palliative care measures by respiratory staff on admission. 45.4% received specialist palliative care team input. The remaining 55% would have benefited, especially if they had been referred preadmission in the community. Only 30.7% had pre-admission discussion regarding point of care.
Conclusion Improving management of terminally ill respiratory patients will require a structured multi-disciplinary approach focusing on long-term review and addressing needs within the community by respiratory and palliative care teams and GP. Early discussion regarding disease prognosis and point of care is paramount in upholding patient autonomy and reducing strain on hospital resources.
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