ED-PALS: A Comprehensive Palliative Care Service for Oncology Patients in the Emergency Department

11583 Background: This was a randomized control trial to estimate the effect of an interventional video on improving palliative care knowledge and acceptability of outpatient services in gynecologic oncology patients. Methods: Women receiving active treatment for gynecologic malignancy (persistent or progressive disease despite primary treatment) were recruited at an academic tertiary care center from 2/2018 to 1/2019 and randomized to: palliative care educational video or non-directive cancer center informational video (control). The primary outcome was desire for referral to palliative care. Function and knowledge were assessed using the Functional Assessment of Cancer Therapy (FACT-G) and the Palliative Care Knowledge Scales. Data analyses were performed using t-tests, Wilcoxon rank sum or Fisher’s exact tests with significance level of α=0.05. Results: 111 women were enrolled. Demographic characteristics were equally distributed between groups (mean age 63.4 vs 65.4 years; 78% vs 82% Caucasian, 58% vs 68% stage III, 71% vs 64% ovarian cancer, 65% vs 72% platinum-sensitive). There was no statistical difference in knowledge scores or in desire for referral to palliative care (29% vs 27%; p=0.79). Secondary analysis showed a statistically significant increase in utilization of palliative care services compared to historic institutional data (8.8% to 29.7%; p=<0.001). Further, those that desired referral had significantly worse FACT-G scores at time of referral choice (table). Conclusions: Use of a palliative care educational video did not increase knowledge or acceptability of palliative care services within this RCT. However, the rate of patients seeking palliative care referral tripled compared to historic rates. Further studies should investigate whether discussion regarding palliative care services alone may increase desire for referral, and if use of Fact-G scores may identify patients in greatest need of services. [Table: see text]

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Can the Introduction of an Integrated Service Model to an Existing Comprehensive Palliative Care Service Impact Emergency Department Visits among Enrolled Patients?

Journal of Palliative Medicine ◽

10.1089/jpm.2008.0217 ◽

2009 ◽

Vol 12 (3) ◽

pp. 245-252 ◽

Cited By ~ 23

Author(s):

Beverley J. Lawson ◽

Frederick I. Burge ◽

Paul McIntyre ◽

Simon Field ◽

David Maxwell

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Emergency Department Visits ◽

Service Model ◽

Integrated Service

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Collateral Damage of the COVID-19 Pandemic: Isolation, Rapid Decision Making and Multifaceted Distress as Observed by an Inpatient Palliative Care Service

Journal of Social Work in End-of-Life & Palliative Care ◽

10.1080/15524256.2021.1894311 ◽

2021 ◽

pp. 1-9

Author(s):

Alissa A. Ulanday ◽

Lindsay B. Minter

Keyword(s):

Decision Making ◽

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Collateral Damage

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77 National Audit of Care At the End of Life (NACEL)—Round Two Findings

Age and Ageing ◽

10.1093/ageing/afab030.38 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

D Hibbert

Keyword(s):

Palliative Care ◽

End Of Life ◽

Care Service ◽

Palliative Care Service ◽

Care Plan ◽

Specialist Palliative Care ◽

Experience Of Care ◽

Outcomes Of Care ◽

Specialist Palliative Care Service ◽

The Right

Abstract NACEL is a national comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the final admission in acute and community hospitals in England and Wales. Mental health inpatient providers participated in the first round but excluded from the second round. NACEL round two, undertaken during 2019/20, comprised: Data was collected between June and October 2019. 175 trusts in England and 8 Welsh organisations took part in at least one element of NACEL (97% of eligible organisations). Key findings include Recognising the possibility of imminent death: The possibility that the patient may die was documented in 88% of cases. The median time from recognition of dying to death was 41 hours (36 hours in the first round). Individual plan of care: 71% of patients, where it had been recognised that the patient was dying (Category 1 deaths), had an individualised end of life care plan. Of the patients who did not have an individualised plan of care, in 45% of these cases, the time from recognition of dying to death was more than 24 hours. Families’ and others’ experience of care: 80% of Quality Survey respondents rated the quality of care delivered to the patient as outstanding/excellent/good and 75% rated the care provided to families/others as outstanding/excellent/good. However, one-fifth of responses reported that the families’/others’ needs were not asked about. Individual plan of care: 80% of Quality Survey respondents believed that hospital was the “right” place to die; however, 20% reported there was a lack of peace and privacy. Workforce Most hospitals (99%) have access to a specialist palliative care service. 36% of hospitals have a face-to-face specialist palliative care service (doctor and/or nurse) available 8 hours a day, 7 days a week. NACEL round three will start in 2021.

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The association between ethnicity, socioeconomic deprivation and receipt of hospital-based palliative care for people with Covid-19: A dual centre service evaluation

Palliative Medicine ◽

10.1177/02692163211022959 ◽

2021 ◽

pp. 026921632110229

Author(s):

Sabrina Bajwah ◽

Polly Edmonds ◽

Emel Yorganci ◽

Rosemary Chester ◽

Kirsty Russell ◽

...

Keyword(s):

Palliative Care ◽

Ethnic Minority ◽

Primary Outcome ◽

Minority Groups ◽

Care Service ◽

Palliative Care Service ◽

Service Evaluation ◽

Socioeconomic Deprivation ◽

Black British ◽

Multivariable Regression

Background: People from ethnic minority groups and deprived socioeconomic backgrounds have worse outcomes from COVID-19. Aim: To examine associations between ethnicity and deprivation with timing of palliative care referral for inpatients with COVID-19. Design: Service evaluation of consecutive patients with COVID-19 referred to palliative care. Sociodemographic (including age, sex, Index of Multiple Deprivation, ethnicity coded as White/non-White) and clinical variables were described. The primary outcome was timing of referral to palliative care. Associations between ethnicity and socioeconomic deprivation with the primary outcome were explored using multivariable regression. Setting/participants: Patients with COVID-19 referred to a hospital palliative care service across two London hospitals February–May 2020. Results: A total of 334 patients were included. 119 (36%) were from a non-White ethnic group; most commonly Black British (77, 23%) and Asian British (26, 8%). A longer time between admission and palliative care referral was associated with male gender (IRR 1.23, 95% CI 1.14–1.34) and lower levels of socioeconomic deprivation (IRR 1.61, 95% CI 1.36–1.90) but not ethnicity (IRR = 0.96, 95% CI 0.87–1.06). Conclusions: This large service evaluation showed no evidence that patients from ethnic minority or more deprived socioeconomic groups had longer time to palliative care referral. Ongoing data monitoring is essential for equitable service delivery.

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54 Developing a palliative care service at Nightingale North West

10.1136/leader-2020-fmlm.54 ◽

2020 ◽

Author(s):

Ben Anderosn

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

North West

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Use of Alfentanil in Palliative Care

Pharmacy ◽

10.3390/pharmacy8040240 ◽

2020 ◽

Vol 8 (4) ◽

pp. 240

Author(s):

José António Ferraz Gonçalves ◽

Filipa Sousa ◽

Lucy Alves ◽

Patrícia Liu ◽

Sara Coelho

Keyword(s):

Chronic Pain ◽

Palliative Care ◽

Retrospective Study ◽

Pain Relief ◽

Renal Impairment ◽

Care Service ◽

Palliative Care Service ◽

Median Number ◽

Second Line ◽

Induction Of Tolerance

Alfentanil is used for chronic pain relief in palliative care. However, there is a dearth of data on its use. For this reason, a decision was made to review the use of alfentanil in palliative care. Retrospective study was carried out in a palliative care service. The files of patients who received alfentanil as an intravenous or subcutaneous continuous infusion for pain relief, between January 2018 and April 2019. In total, 111 patients received alfentanil out of 113 admissions. Of them, 56 were male, and the median age was 70 years. The median number of days on alfentanil was 6 (range 1 to 129). The most frequent primary reasons for switching to alfentanil was uncontrolled pain in 52 (46%) patients and renal impairment in 24 (21%) patients. The median 24-h initial dose of alfentanil was 4 mg (1–20), and the median final 24-h dose of alfentanil was 5 mg (1–60), (p < 0.001). The initial 24-h median number of rescue doses was 2 (0–8), and the final median number of rescue doses was 1 (0 to 8), (p = 0.025). In 56 patients who were on alfentanil for at least 7 days, the dose decreased in 3 (5%), remained stable in 10 (18%) and increased in 43 (77%). The patient on alfentanil for 129 days maintained the same dose throughout that period. Alfentanil can be a useful second-line opioid. The induction of tolerance does not seem to be particularly rapid with alfentanil.

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