Dr Jane GibbinsConsultant in Palliative Medicine

What is important to patients• Symptom control• Time and support to prepare• Priorities and preferences listened to & accorded with• Well coordinated & integrated services• Family support and reduction in burden on family

Singer et al. JAMA 1999Steinhauser et al. JAMA 2000

Heyland et al. CMAJ 2006 Hancock et al. JPSM 2007

Inpatient units• 24/7 admissions• High complexity• Multi-disciplinary team

- Holistic care with forward/parallel planning• Daily consultant reviews

- Early tailored plan• Short length of stay

- Average 7 days

Patient reported outcome measures

• St Christopher’s Index of Patient Priorities (SKIPP) -Validated tool - Main concern/symptom - Quality of life• 150 consecutive admissions• 79% symptoms controlled within 3/7

Outcome measures

Quality of life

1 2 3 4 5 6 7 80

5

10

15

20

25

30

35

40

Pre (%)

Post (%)

QOL Score (1=poor 8=Excellent)

Mean change 2.6 to 4.65 p<0.001

Hospice stay

• Crisis management/urgent problem

- Symptom control

• Important issues/concerns/goals

- Time and support to prepare - Priorities and preferences listened to & accorded with

24 hour advice line

Outreach services

• Patients seen at the right time and place

– Home, Care Home or Community Hospital

– Hospice Outpatient

– Hospital Oncology Outpatients

– Joint Pain & Palliative Care Service

Specialist services

Lymphoedema

Day unit - Blood transfusions- Bisphosphonates

Education

UndergraduatesOne of the most extensive medical palliative care modules in the UK

PostgraduatesNursing staff5 GP trainees per year

Steering projects• Cross setting

collaborative education– Symptom control guidance– Acute trust, Community,

Ambulance, Hospices– 1200 HCP to date with QI

methods

Improved unable to comment *Did not improve0

5

10

15

20

25

30

26

3

1

Perceived effect of APG on patients' symp-tom control at EoL

‘*’No change to my practice in these recent cases, but has been helpful resource to refer to when checking prescribing / converting doses, so has made my work more efficient and po-tentially safer.’

Knowledge scores

1 2 3 4 50

10

20

30

40

50

60

BeforeAfter

Scores

Perc

enta

ge (%

)

Research

• Research work– Outcomes at CHC– Intrathecal project at CHC– Junior doctors with

Peninsula Deanery• National involvement

– Papers– Conferences– Editorial board

ChallengesGenerally• Increasing demands on service/changing population, especially non

cancer population• Identification of patients into SPC services• No substantive Palliative Care/EOL lead in CCG

Cornwall Hospice Care• Funding• Facilities that could be used by more individuals; day unit

SPC services being delivered by different organisations• Different governance and expectations• No format to enable shaping of service to address changing patient needs• No formal SLA/funding streams

Caring for our community

Domiciliary visitsOutpatient clinics

Pain and Palliative care serviceCommunity SPCN team MDT

and adviceSupport to Hospital team at

RCHT24 hour advice line

Education/Research/Project work

Aspiration

Patient and family

Questions/discussion