Background PTHC has a longstanding interest in neuro-degenerative conditions (NDC) and hosts bi-monthly NDC multi-disciplinary team (MDT) meetings on its two sites. Despite other robust care pathways, assessment of cognitive and behavioural function was not standardised. ECAS was identified as the most suitable tool to improve this aspect of care.
Methods A 12-month hospice project was designed to:
Raise awareness of cognitive and behavioural impairment in MND and ECAS
Screen all caseload MND patients for suitability to use ECAS and carry out screens. MND Association (MNDA) provided support with a small grant and resources.
All MND patients were assessed during MDT meetings/other clinical encounters. Offers of the screen (including written information) were made and ECAS was facilitated by the most appropriate clinician.
Results There were 58 MND caseload patients during 1.9.2016–30.10.2017:
10 (17%) completed ECAS
25 (43%) were offered ECAS (3 declined; 20 were awaiting decisions/appointments at the time of submission; 1 did not attend the appointment; 1 did not proceed during the appointment)
22 (38%) were not considered (2 did not speak English, 7 died before discussion, 13 were too ill/severely cognitively impaired)
ECAS was facilitated by doctors, physiotherapists and occupational therapists in clinics, care homes and homes. Education activities included a dedicated teaching session and dissemination of MNDA booklets and ECAS.
Discussion ECAS worked best in patients with good insight who were motivated to improve their management. The survey is long to complete and dedicated time was need for completion, usually outside regular clinics. Cognitive impairment is a sensitive topic and the introduction of ECAS was most successful following a cue from a patient or after building a trusting rapport before the introductory discussion. Use of ECAS has triggered the hospice collaboration in ongoing national research of the tool.
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