Background Transitions of care between acute hospital cancer services and palliative care services can be challenging for patients. This, combined with the limitations of time and clinic space at our local acute hospital, led us to develop joint clinics with cancer site specific clinical nurse specialists (CNSs) and specialist hospice staff, at the hospice site.

Aim

• To provide increased support for people with a cancer diagnosis who have a palliative prognosis

• To improve coordination of care for this group and provide access to the combined expertise of cancer site specific CNSs and specialist palliative care health professionals

• To encourage earlier access to specialist palliative care services and to smooth transitions between acute care and palliative care.

Methods The clinics were first piloted with patients with upper gastrointestinal (GI) cancers and cancers of unknown primary. The CNS for this tumour site provides clinics collaboratively with a palliative care specialist senior staff nurse. A lung cancer clinic was then started, which is run with the CNS and a palliative care specialist physiotherapist, providing multidisciplinary support. Each clinic attendee is assessed holistically and action is taken as necessary according to this assessment. This may include psychological support, symptom management or referral to other services. Follow up appointments are booked according to patient need.

Results Since the start of the clinics, 134 patients have been supported, attending 198 appointments between them. Of those who have attended the joint clinics, 80% have gone on to access other hospice services. Patient feedback has been very positive and working relationships between the acute hospital and the hospice have been much improved.

Conclusion A collaboration between a hospice and an acute hospital has provided improvements in co-ordination and quality of care, as well as early access to hospice services for patients with upper GI and lung cancer.