P-193 Deconstructing the silos: innovative commissioning of palliative care consultants within a local healthcare economy may improve co-ordinated whole person care for patients with generalist and specialist palliative care needs

Abstract Background Specialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC. However, little is known about complex needs on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on referral to a hospice service. Methods Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived to be influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly. Conclusions Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed SPC knowledge or support to meet their needs. Hospices need to provide greater clarity regarding who should be referred, when and for what purpose. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of SPC input.

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Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes

Palliative Medicine ◽

10.1177/0269216319891077 ◽

2020 ◽

Vol 34 (5) ◽

pp. 571-579 ◽

Cited By ~ 4

Author(s):

Liz Forbat ◽

Wai-Man Liu ◽

Jane Koerner ◽

Lawrence Lam ◽

Juliane Samara ◽

...

Keyword(s):

Palliative Care ◽

Length Of Stay ◽

Care Home ◽

Care Homes ◽

Randomised Control Trial ◽

Specialist Palliative Care ◽

Stepped Wedge ◽

Model Of Care ◽

Care Needs ◽

Palliative Care Needs

Background: Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home. Aim: To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital. Design: Stepped-wedge randomised control trial. The primary outcome was length of stay in acute care (over 24-h duration), with secondary outcomes being the number and cost of hospitalisations. Care homes were randomly assigned to cross over from control to intervention using a random number generator; masking was not possible due to the nature of the intervention. Analyses were by intention to treat. The trial was registered with ANZCTR: ACTRN12617000080325. Data were collected between 1 February 2017 and 30 June 2018. Setting/participants: 1700 residents in 12 Australian care homes for older people. Results: Specialist Palliative Care Needs Rounds led to reduced length of stay in hospital (unadjusted difference: 0.5 days; adjusted difference: 0.22 days with 95% confidence interval: −0.44, −0.01 and p = 0.038). The intervention also provided a clinically significant reduction in the number of hospitalisations by 23%, from 5.6 to 4.3 per facility-month. A conservative estimate of annual net cost-saving from reduced admissions was A$1,759,011 (US$1.3 m; UK£0.98 m). Conclusion: The model of care significantly reduces hospitalisations through provision of outreach by specialist palliative care clinicians. The data offer substantial evidence for Specialist Palliative Care Needs Rounds to reduce hospitalisations in older people approaching end of life, living in care homes.

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125 Can the SPICT be applied retrospectively to identify patients with unmet specialist palliative care needs who attend ED with breathlessness?

10.1136/spcare-2020-pcc.145 ◽

2020 ◽

Author(s):

Rebecca Gardiner ◽

Gilli Erez

Keyword(s):

Palliative Care ◽

Specialist Palliative Care ◽

Care Needs ◽

Palliative Care Needs

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Seeking Excellence in End of Life Care (SEE Care): A Multi-Centered Acute Hospitals Service Evaluation

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211027815 ◽

2021 ◽

pp. 104990912110278

Author(s):

Simon Tavabie ◽

Anja Berglund ◽

David Barclay ◽

Steve Bass ◽

Naomi Collins ◽

...

Keyword(s):

Palliative Care ◽

End Of Life Care ◽

Service Evaluation ◽

Hospital Inpatient ◽

Life Care ◽

Specialist Palliative Care ◽

Care Needs ◽

Care Plans ◽

Inpatient Population ◽

Palliative Care Needs

Context: A proportion of UK hospital inpatients have palliative care needs but do not access specialist services. Objectives: To contemporaneously evaluate the significance of unmet specialist palliative care needs within the hospital inpatient population. Methods: Prospective multi-centered service evaluation was conducted through 4 snapshots across 4 acute NHS hospital trusts. All patients identified as dying in each hospital were included. Data extraction included symptom burden, medications and completion of care plans. Results: End-of-life care plans were completed for 73%, symptom-focused prescribing present in 96%. Symptoms were not well managed for 22%, with 4% suffering moderate to severely. Specific intervention was triggered in 56% of patients, consisting of prescribing advice and holistic support. Conclusion: There are significant unmet specialist palliative care needs within the hospital inpatient population. Contemporaneous data collection coupled with an outreach approach helps palliative care services better understand the experiences of dying people, alongside where improvement is needed.

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What Makes Palliative Care Needs “Complex”?: A Multisite Sequential Explanatory Mixed Methods Study of Patients Referred to Specialist Palliative Care

10.21203/rs.3.rs-99020/v1 ◽

2020 ◽

Author(s):

Anne Finucane ◽

Connie Swenson ◽

John I MacArtney ◽

Rachel Perry ◽

Hazel Lamberton ◽

...

Keyword(s):

Palliative Care ◽

Focus Groups ◽

Healthcare Professionals ◽

Psychological Needs ◽

Care Providers ◽

Specialist Palliative Care ◽

Care Needs ◽

Complex Needs ◽

Sequential Explanatory ◽

Palliative Care Needs

Abstract Background: Specialist palliative care (SPC) providers tend to use the term ‘complex need’ to refer to the needs of patients who require SPC. However, little is known about “complex needs” on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on first referral to a hospice service. Methods: Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results: Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived as influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly.Conclusions: Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed specialist palliative care knowledge or support to meet their needs. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of specialist palliative care input.

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Context and mechanisms that enable implementation of specialist palliative care Needs Rounds in care homes: results from a qualitative interview study

BMC Palliative Care ◽

10.1186/s12904-021-00812-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Jane Koerner ◽

Nikki Johnston ◽

Juliane Samara ◽

Wai-Man Liu ◽

Michael Chapman ◽

...

Keyword(s):

Palliative Care ◽

Evidence Base ◽

Trial Registration ◽

Care Homes ◽

Mechanisms Of Change ◽

Specialist Palliative Care ◽

Care Needs ◽

Palliative Care Needs ◽

Robust Evidence

Abstract Background Improving quality of palliative and end of life care in older people’s care homes is essential. Increasing numbers of people die in these settings, yet access to high quality palliative care is not routinely provided. While evidence for models of care are growing, there remains little insight regarding how to translate evidence-based models into practice. Palliative Care Needs Rounds (hereafter Needs Rounds) have a robust evidence base, for providing palliative care in care homes, reducing resident hospitalisations, improving residents’ quality of death, and increasing staff confidence in caring for dying residents. This study aimed to identify and describe the context and mechanisms of change that facilitate implementation of Needs Rounds in care homes, and enable other services to reap the benefits of the Needs Rounds approach to care provision. Methods Qualitative interviews, embedded within a large randomised control trial, were conducted with a purposive sample of 21 staff from 11 care homes using Needs Rounds. The sample included managers, nurses, and care assistants. Staff participated in individual or dyadic semi-structured interviews. Implementation science frameworks and thematic analysis were used to interpret and analyse the data. Results Contextual factors affecting implementation included facility preparedness for change, leadership, staff knowledge and skills, and organisational policies. Mechanisms of change that facilitated implementation included staff as facilitators, identifying and triaging residents, strategizing knowledge exchange, and changing clinical approaches to care. Care home staff also identified planning and documentation, and shifts in communication. The outcomes reported by staff suggest reductions in hospitalisations and problematic symptoms for residents, improved staff skills and confidence in caring for residents in their last months, weeks and days of life. Conclusions The significance of this paper is in offering care homes detailed insights into service contexts and mechanisms of change that will enable them to reap the benefits of Needs Rounds in their own services. The paper thus will support the implementation of an approach to care that has a robust evidence base, for a population under-served by specialist palliative care. Trial registration ACTRN12617000080325.

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Understanding the palliative care needs and experiences of people with mesothelioma and their family carers: An integrative systematic review

Palliative Medicine ◽

10.1177/02692163211007379 ◽

2021 ◽

pp. 026921632110073

Author(s):

Madeleine Harrison ◽

Clare Gardiner ◽

Bethany Taylor ◽

Stephanie Ejegi-Memeh ◽

Liz Darlison

Keyword(s):

Systematic Review ◽

Palliative Care ◽

Information Needs ◽

Empirical Studies ◽

Cochrane Library ◽

Specialist Palliative Care ◽

Family Carers ◽

Care Needs ◽

The Impact ◽

Palliative Care Needs

Background: People with mesothelioma and their families have palliative care needs throughout the relatively short trajectory of their illness. Aim: To describe the palliative care needs and experiences of people with mesothelioma and their family carers. Design: Integrative systematic review with narrative synthesis (PROSPERO: CRD42020190115). Data sources: MEDLINE, CINAHL, PsycINFO and the Cochrane Library were searched for articles published between 01 January 2000 and 10 May 2020. Articles were included if they presented empirical studies or comprehensive reviews including information about the palliative care needs and experiences of people with mesothelioma and their family carers. Results: The search yielded 508 articles, 14 were included in the analysis. A cross cutting theme of ‘uncertainty’ was identified encompassing five themes: (1) organisation and co-ordination of services, (2) communication and information needs, (3) management of care needs and high symptom burden, (4) consideration of the impact of seeking compensation and (5) family carer needs. Our findings demonstrate that people with mesothelioma want a co-ordinated, team-based approach to palliative care with a named point of contact. Whilst carers value and benefit from early referral to specialist palliative care, this does not necessarily reflect the outcomes and views of patients. Conclusion: The evidence base around the palliative care needs and experiences of people with mesothelioma and their carers needs to be strengthened. The results of this review support the need to develop a greater understanding about the role non-specialist palliative care clinicians’ play in providing generalist palliative care for people with mesothelioma and their carers.

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Improving specialist palliative care in residential care for older people: a checklist to guide practice

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2017-001332 ◽

2017 ◽

Vol 8 (3) ◽

pp. 347-353 ◽

Cited By ~ 7

Author(s):

Liz Forbat ◽

Michael Chapman ◽

Clare Lovell ◽

Wai-Man Liu ◽

Nikki Johnston

Keyword(s):

Palliative Care ◽

Older People ◽

Residential Care ◽

Participant Observation ◽

Qualitative Interviews ◽

Symptom Burden ◽

Ethnographic Study ◽

Specialist Palliative Care ◽

Care Needs ◽

Palliative Care Needs

ObjectivesPalliative care needs rounds are triage meetings that have been introduced in residential care for older adults to help identify and prioritise care for people most at risk for unplanned dying with inadequately controlled symptoms. This study sought to generate an evidence-based checklist in order to support specialist palliative care clinicians integrate care in residential nursing homes for older people.MethodsA grounded theory ethnographic study, involving non-participant observation and qualitative interviews. The study was conducted at four residential facilities for older people in one city. Observations and recordings of 15 meetings were made, and complimented by 13 interviews with staff attending the needs rounds.ResultsThe palliative care needs round checklist is presented, alongside rich description of how needs rounds are conducted. Extracts from interviews with needs rounds participants illustrate the choice of items within the checklist and their importance in supporting the evolution towards efficient and effective high-quality specialist palliative care input to the care of older people living in residential care.ConclusionsThe checklist can be used to support the integration of specialist palliative care into residential care to drive up quality care, provide staff with focused case-based education, maximise planning and reduce symptom burden for people at end of life.

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