Sharing Current Scottish Practice

Poster abstracts of the month: September

The SPPC Annual Conference in 2017 featured 46 poster displays, sharing work and research underway across Scotland. Each month, this blog focuses on the content of a few of these posters. This month, we focus on five of these:

• Palliative and end of life care in the community
• Palliative and end of life care research in Scotland 2006 – 2015: A scoping review
• Palliative care in the ICU setting
• Palliative care from diagnosis to death: developing a rationale
• Palliative intent treatment for head and neck cancer: an analysis of local practice and outcomes

Palliative and end of life care in the community

Author(s)

Robert Sanders; Michelle Church; Paul Baughan

How the Living Well in Communities team - part of Healthcare Improvement Scotland's Improvement Hub - will support six Health and Social Care Partnerships across Scotland to improve the identification and care coordination of people with palliative care needs, fulfilling commitment one of the Strategic Framework for Action for Palliative and End of Life Care.

Each test site will consider ways to improve identification of people with a palliative need, develop anticipatory care planning and test community based models of care that increase opportunities for both generalist and specialist palliative care in the community.

The improvement programme will run for two years and learning from the tests of change will be shared during the lifetime of the programme in the form of learning assets and events.

Palliative and end of life care research in Scotland 2006 – 2015: A scoping review

Author(s)

Anne Finucane; Emma Carduff; Jean Lugton; Stephen Fenning; Bridget Johnston; Marie Fallon; David Clarke; Juliet Spiller; Scott A. Murray

Background: The Scottish Government set out its 5-year vision to improve palliative care in its Strategic Framework for Action 2016-2021. This includes a commitment to strengthening research and evidence based knowledge exchange across Scotland. A comprehensive scoping review of Scottish palliative care research was considered an important first step.

Method: Five databases were searched with relevant MeSH (Medical Subject Headings) terms and keywords; additional papers authored by members of the Scottish Palliative and End of Life Care Research Forum were added.

Results: In total, 1,919 papers were screened, 496 underwent full text review and 308 were retained in the final set. The top three areas were experiences and/or needs; services and settings; and physical symptoms. 58 papers were concerned with palliative care for people with conditions other than cancer – nearly one fifth of all papers published.

Conclusion: The findings reveal a considerable increase in palliative care research output over the last decade when compared with a similar Scottish review in 2006 and the 151 papers identified in a review of Irish palliative care research in 2013. The Scottish Research Forum in Palliative care will now disseminate key findings to clinicians, service managers and policy-makers to improve the reach and quality of palliative care.

Palliative care in the ICU setting

Author(s)

Dr Caroline Burke; Dr Niamh Feely; Dr Patricia Sheahan

A quality improvement project looking at the number of deaths in the ICU setting in a peripheral hospital in Kerry, Ireland in 2016 with regard to the prevalence of referrals to the Palliative Care Team and analysis of the cases where palliative care referral may have improved patient care. The problematic nature of providing expert palliation in critical and acute settings has been well recognised.

What is the definition of a "good death"? A significant number of seriously ill patients undergo overly aggressive management, inadequate pain control and suffer as a result of poor communication. There is huge variation in the withdrawal and withholding of therapy in European ICUs. This study was a retrospective chart review. The number of deaths in the ICU in UHK in 2016 was quantified at 40. Charts were analysed for data: Was the death expected or unexpected? If expected was the Palliative Care Team involved? If palliative care was not involved could they have improved care? Was there a missed opportunity for palliative input? 35 deaths were deemed to be expected. Of the 35 patients whose deaths were expected there were 9 incidences of Palliative Care Team involvement. There were 8 missed opportunities for Palliative Care Team involvement.

Palliative care from diagnosis to death: developing a rationale

Author(s)

Murray SA; Kendall M; Mitchell G; Moine S; Amblas-Novellas J; Boyd K

Early palliative care may prolong life as well as improve its quality, but it is frequently only started in the last weeks or days of life and largely for people with cancer. Its huge potential to minimise and prevent pain and distress across illnesses is not realised. This poster shows how early palliative care may be triggered for people living and dying from different conditions. It also points out the elements of palliative care that might often be relevant for people at different points in their illness. Palliative care might be triggered by non-physical needs which may alter greatly as the illness progresses.

Palliative intent treatment for head and neck cancer: an analysis of local practice and outcomes

Author(s)

Finn Begbie; Catriona Douglas; Fiona Finlay; Jenny Montgomery

Management of head and neck cancer is a complex area and there is often significant morbidity associated with treatment. Management options are divided into those given with curative intent and those given with palliative intent. Palliative treatment, sometimes described as best supportive care, can involve a wide variety of treatments. There is little consensus, and indeed a paucity of literature, on which palliative treatments should be provided for primary head and neck cancer and predicting outcome remains a grey area. The present study sought to delineate local practice and outcomes in patients treated with palliative intent in terms of survival, treatment received and associated morbidity in order to better inform treatment decisions in the palliative management of head and neck cancer.