Ann Griffiths

Multi-professional-delivered enhanced supportive care improves quality of life for patients with incurable cancer

BACKGROUND: Enhanced supportive care (ESC) promotes the earlier implementation of supportive care within cancer care. While earlier supportive care has been demonstrated to improve patient outcomes, the model of delivery is variable. The Clatterbridge Cancer Centre has developed a multi-professional delivered model with clinical nurse specialists providing ongoing patient review and care. METHOD: A retrospective single-system design was used to assess longitudinal changes in Integrated Palliative Care Outcome Scale (IPOS) scores as indicators of quality of life. For other outcomes, a retrospective case control analysis was undertaken. RESULTS: Statistically significant improvements in all IPOS scores were observed for patients attending ESC. Compared to controls, quantitative outcomes included prolonged survival and reduced chemotherapy-related mortality. Multi-professional delivered ESC successfully improves quality of life and outcomes.

P-83 Enhancing bereavement support in a tertiary cancer centre: a quality improvement study

Background Grief is a natural response to the loss of a loved one but can have the potential for long term adverse effects. Bereavement services are therefore essential to provide support and to identify those at risk of harm. A ‘day after death service’ for bereaved persons is a longstanding component of bereavement care at our tertiary cancer centre. Bereaved persons are met by a clinical nurse specialist the day after the death for a face to face discussion and support needs assessment. This system aims to improve support and identify those at risk of pathological grief reactions. Aim Conduct a quality improvement project aimed at enhancing bereavement support at our centre by incorporating feedback from bereaved persons into trust-wide education and care quality indicators. Methods A 12 month retrospective audit was undertaken to evaluate bereavement service outcomes.This was combined with feedback from stakeholders to develop a PDSA quality improvement cycle. Results At baseline 51 deaths were recorded in 12 months. 42 people agreed to ongoing support following accessing the day after death service. 39 people did not require any further support following a single phone call. Three bereaved persons needed additional support due to prolonged/pathological grief, and were supported appropriately. Stakeholder satisfaction surveys revealed an 88% approval rating for emotional support and practical help, and 100% would recommend the service to others. Qualitative constructive feedback suggested enhancing methods of detecting people at high risk of pathological grief and developing an action-orientated approach to bereavement support. Conclusion Bereavement care incurs practical as well as emotional challenges. Despite positive feedback regarding the emotional support provided by our service, there are practical areas for development. The next step of our project is to incorporate these changes into education and information processing tools, before re-evaluating progress.

Mind the gap: do tertiary cancer centres need 24 hour access to specialist palliative care services?

Background The National Institute for Clinical Excellence recommended that Cancer Networks should provide 24 h access to specialist palliative care telephone advice. The Manual of Cancer Services 2004 suggested that a telephone advice service should be available to core members of cancer MDTs. Clatterbridge Centre for Oncology is a tertiary cancer centre with more than 7000 new patients every year. A specialist palliative care service is available 7 days per week 9–5 but the 24 h access is provided by an informal arrangement with a single clinician. Healthcare professionals working in tertiary cancer centres often have an increased knowledge of palliative care and it has been suggested that 24 h access to specialist advice may not be as important as for district general hospitals. Aim To explore the views of healthcare professionals working in a tertiary cancer centre about the need for 24 h access to specialist palliative care advice. Method A questionnaire was distributed to healthcare professionals in a tertiary cancer centre asking for their views on: areas of concern use of current informal advice provision impact of advice on patient care. Results The questionnaire was distributed to 129 staff. The response rate was 47%. In the previous 4 weeks advice had been required on 46 occasions. 54% of staff had requested advice. 97% found the advice very helpful.100% felt that the advice had a positive impact on patient care. Conclusion This survey demonstrated that staff in a tertiary cancer centre had palliative care educational needs and valued access to specialist palliative care advice believing that it had a positive impact on patient care.