Sharing Current Scottish Practice

Poster Abstracts of the Month - May

The SPPC Annual Conference in 2013 featured 36 poster displays, sharing work and research underway across Scotland. Each month, this blog will focus on the content of a few of these posters.

This month, we focus on:

Hospice Based Ultrasound Scanning: The First 12 months

How do Gold Standard Framework meeting support palliative care delivery as part of primary care services? A observational study

How good is primary care at identifying patients who need palliative care? A mixed methods study

Identification needs for end of life care teaching amongst Junior Doctors

Influencing National Policy and Practice Frameworks: A hospice perspective

 

Hospice Based Ultrasound Scanning: The First 12 months

Author(s): Kemp R; McKeown A (Prince and Princess of Wales Hospice, Glasgow)

Paracentesis of malignant ascites can provide symptomatic benefit in the short term with a well tolerated, minimally invasive procedure. There is anecdotal evidence that Hospices are increasingly reluctant to undertake paracentesis due to perceived risk. Ultrasound scanning (USS) means patient selection can be more accurate, and the procedure safer.

With the help of a St James Place Grant, the Prince and Princess of Wales Hospice (PPWH) were able to purchase a Sonosite Micromax. The staff then undertook training allowing them to undertake abdominal scans independently.
Over the 12 months from September 2012 to August 2013, PPWH recorded all USS scans completed within the hospice for a range of clinical reasons. We recorded findings, outcomes, complications and tolerability of procedures.
This poster will present the results of the first 12 months of utilising hospice based USS.

The key goal was to create a system where patients with malignant ascites could be assessed either in their own home or the hospice, and avoid the need for hospital admissions/investigations.

While the service is still being developed, we have managed to put in place the framework for such a system in a short space of time.

How do Gold Standard Framework meetings support palliative care delivery as part of primary care services? A observational study

Author(s): Baughan P; Forbat E; Haraldsdottir E (NHS Forth Valley; Strathcarron Hospice, Denny)

Background: The Gold Standard Framework (GSF) is recognised tool to support GP practices to organise high quality Palliative at home. Whilst uptake of the GSF is widespread there is a lack of evidence to demonstrate how it supports GPs and district nurses to deliver palliative care in primary
care. This small study provides insight into the use of GSF meetings within 3 GP practices within NHS Forth Valley.

Methods: Eight GSF meetings were observed. Thematic analysis was used to analyse data, providing order to the data set and allowing for key themes to emerge and be identified.

Findings: Key themes that emerged highlighted issues around the criteria for the palliative care register, how GSF meetings were constructed and the main focus of the dialogue.

Conclusion: The professionals attending the GSF meetings appeared to have a good knowledge of the patients on their palliative care register without the need to refer to medical notes. The ‘tools’ and ‘checklists’ developed for use with the GSF did not appear to be used in the practices observed. There appeared to be a challenge around identifying who and when patients should be placed on the Palliative Care register. There is ongoing uncertainty around how to interpret ‘the
surprise question’.

How good is primary care at identifying patients who need palliative care? A mixed methods study

Author(s): Finucane AM; McCutcheon H; McLoughlin P; Murray SA; Oxenham D; Zheng L (Marie Curie Hospice Edinburgh, NHS Lothian, University of Edinburgh)

Note: This poster describes data that was published in the European Journal of Pallaitive Care in Sepember 2013; and previously presented at the EAPC conference in Prague.

Background: Patients with all advanced progressive diseases may benefit from an early palliative care approach. Traditionally palliative care services have served cancer patients in their last weeks of life. We aimed to document variations in the identification of patients for palliative care.

Design: Retrospective case note review of all patients who had died in nine GP practices in the UK over 12 months; semi-structured interviews with health care professionals. Identification was defined as the patient being included on the practice palliative care register.

Results: The nine practices yielded 684 deaths: 29% from cancer, 25% from organ failure, and 23% from frailty or dementia. At death, 75% of patients with cancer had been identified formally for palliative care compared with 20% of non-cancer patients. Patients were formally identified for a palliative approach seven weeks before death. A cancer diagnosis, practice multi-disciplinary
meetings, and financial incentives facilitated identification.

Conclusion: Only 20% of non-cancer patients were ever formally identified for palliative care. If they were identified, patients are recognised too late to benefit fully. Better and earlier identification of all patients who may benefit from palliative care is vital so that care can be planned to improve
their quality of life and death.

Identification needs for end of life care teaching amongst Junior Doctors

Author(s): Kreeger L; Nixon I; Prentice J (Kingston Hospital Trust, Surrey)

Introduction: Issues surrounding end of life care (EoLC) can be challenging for doctors; especially newly qualified doctors. Education and development of the workforce is a central theme in end of life care directives both local and national.

We sought to seeks the views of foundation year 1 (FY1) doctors in a district general hospital, London.

Methods: Nineteen questionnaires were completed by FY1 doctors. A combination of white paper spaces and Likert item questions were used to investigate concerns and confidence surrounding EoLC. Preferences for teaching styles were elicited.

Results: Themes that FY1 doctors find difficult centred around communication. The most common concern was talking to relatives, predicting end of life and prescribing syringe drivers. Doctors felt least confident around predicting patients that are in the last year of life. Formal teaching, breakfast
sessions and groups work appear to be acceptable ways to deliver teaching.

Conclusion: Tuesday morning short ‘breakfast’ teaching sessions were developed by the Hospital Palliative Care Team on the medical unit, in addition to the more formal education programme already provided to address difficulties in providing relevant teaching for busy ward-based trainee doctors.

Implementing the Cambridge Breathlessness Intervention Service in Ardgowan Hospice

Author(s): Hendry S; McNeil L; Murray R; Thorp R (Ardgowan Hospice, Greenock)

Background: Breathlessness is a common, distressing and debilitating symptom in patients with advanced cancer and other life-limiting conditions. Managing breathlessness is a core component of specialist palliative care.

Aims:
1. To review our breathlessness management service against best practice models of care and develop our service in line with these.
2. To increase referrals of patients with non-malignant disease.
3. To improve outcomes for patients in terms of overall breathlessness and distress caused by this.
4. To reduce hospital admissions.

Method:

Redesign of service: specific features of the CBIS were identified to improve existing service. Stakeholder engagement – views of potential referrers sought.
Capacity review – led to fourfold increase in first appointments.
New service launched and promoted.
Audit of service.

Results:
a) Pre-implementation audit:
10 patients identified; 6 had completed notes for evaluation
All six had lung cancer
All six were referred by the lung cancer CNS
All six reported improvements in SOB and distress
Average change in SOB at worst was -3.7
10 Poster and display list 2013
Average change in distress at SOB was -3.3

b) Post-implementation audit:
10 patients identified; 10 evaluated
Spread of diagnoses – 7 lung cancer, 1 breast cancer, 2 heart failure
Spread of referrers – Lung cancer CNS:6 ;Heart failure CNS:2; Hospice CNS:2
One patient had VAS worst scores which increased +3, but reduced by -3 for distress
Otherwise all showed improvement in scores
Average change in SOB at worst was -2.1
Average change in distress at SOB was -1.9
No admissions reported in either period.