Palliative Care: Are we doing
enough?
Louise Burgess
and
Josie Daines – Wright
June 2012
The Christie NHS Foundation Trust
Aims
• The Christie Hospital and Haematology Transplant Unit
• Definition of Palliative Care
• Advance Care Planning and Palliative Care Tools
• The North West End of Life Care Model
• Palliative Care and Haematology
• Our Review
• Recommendations
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The Christie NHS Foundation Trust
The Christie NHS Foundation Trust
Palliative Care
“an approach that improves the quality of life of
patients and their families facing the problems
associated with life threatening illness, through the
prevention and relief of suffering by means of early
identification and impeccable assessment and
treatment of pain and other problems, such as
physical, psychosocial and spiritual”
(WHO 2002)
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What is Advance Care Planning?
• Discussion between patient and professional
• Addresses patient’s:
- understanding of illness and prognosis
- concerns
- values or personal goals for future care
- preferences for care
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Palliative Care Tools
• Advance Directives – Including
Cardiopulmonary Resuscitation
Not
for
• Gold Standard Framework (GSF)
• Sheffield Profile for Assessment and Referral to
Care (SPARC) Holistic Assessment
• Preferred Priorities for Care
• Rapid Discharge Pathway
• Liverpool Care of The Dying Pathway
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The North West End of Life Care Model
Gold Standards
Framework (GSF)
Preferred Priorities for Care
(PPC)
Rapid Discharge Pathway
(RDP)
Liverpool Care Pathway for the
Dying (LCP)
1
Advancing
disease
1 year and
beyond
2
Increasing
decline
6 months
3
4
Last Days
of Life
First Days
after Death
Death
5
Bereavement
1 year
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Palliative care and Haematology
• Infrequent palliative care (NICE 2003)
• Palliative care in Haematology
researched (Grundy 2006)
is
under
• Complex and uncertain Haematology pathway
(Howell 2010)
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Objectives
To review the palliative and end of life care of
Allogeneic Transplant patients that died between
the period of March 2010 and October 2011
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Method
• Retrospective
review
of
12
Allogeneic
Transplant patients that died between 2010 and
2011
• Information reviewed:
- Length of stay
- Place of death
- Implementation of Liverpool Care Pathway
- Involvement of Hospital Palliative Care
Support Team
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Results
•
Length of stay – 18 – 164 days, median 50
days
•
3 out of 7 patients died on the Liverpool Care of
the Dying Pathway
•
2 out of 12 died in their preferred place of care
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Place of Death
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Cause of Death
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Reason of Referral to Palliative Care
Support Team
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Key Results
• Referrals to palliative care support team were for
advice on end of life care
• Patients with palliative care team involvement
were transplant related mortalities
• Patients with relapsed disease had no referrals
made to the palliative care support team
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Conclusions and Recommendations
• Palliative and supportive care needs going
unrecognised and and specialist referrals not
being made (NICE 2004)
• The use of service models to ensure that
patients, their families, and carer, all receive
support and care to help them cope with cancer
and its treatments at all stages (NICE 2004)
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Recommendations
• Check patient understanding of their prognosis
• Utilising SPARC holistic assessment tool at key
stages of a patients disease
• Encourage health care professionals in the use
of the Gold Standard Framework
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References
•
•
•
•
•
•
•
Department of Health (2000) The NHS Cancer Plan: a plan for investment, a plan for
reform. London
Department of Health (2008) End of Life Care Strategy: Promoting High Quality Care
for All Adults at the End of Life. The Stationery Office, London
Grundy M (2006) Nursing in Haematological Oncology 2nd Edition. Bailliere Tindall
Elsevier. Edinburgh
Howell DA, Roman E, Cox H, Smith AG, Patmore R, Garry AC and Howard MR
(2010) Destined to die in hospital? Systematic review and meta-analysis of place of
death in haematological malignancies. BMC palliative care 9:9
Kelly D, Ross S, Gary B and Smith P (2000) Death, dying and emotional labor:
problematic dimensions of the bone marrow transplant nursing role? Journal of
Advanced Nursing. 32:4 pp 952 – 960
National Institute for Clinical Excellence (2003) Improving Outcomes in
Haematological Cancers: The Manual. London
National Institute for Clinical Excellence (2004) Improving Supportive and Palliative
Care for Adults with Cancer. London
The Christie NHS Foundation Trust
Thank you for listening
The Christie NHS Foundation Trust