CN29 Integration and development of palliative care in a comprehensive cancer centre: A quality improvement project

Abstract

In the region of Stockholm, we have one comprehensive cancer centre, and two other hospitals, responsible for cancer treatment, support and follow-up. In addition, there´s over 40 specialized palliative care ( SPC ) home-care teams in the region, that are responsible for symptom management and support when needed during the cancer care trajectory. Research from the region regarding cancer care, concluded that there´s risk for aggressive care at End-of life (EOL), fragmentation between caregivers (the oncology team and SPC at home), and a lack of clear goals-of care. In line with ongoing strategic work at Karolinska comprehensive cancer centre (KCCC), we found areas in need of improvement; EOL care, as well as collaboration between KCC and SPC at home. A nurse-led, multi-professional group initiated a project, aiming to improve palliative care and collaboration between KCCC and SPC at home. The planned activities directed towards EOL care, strives to implement structured protocols for EOL nursing care, as well as systematic registration and evaluation of quality indicators for EOL care. Further, we conducted a workshop with the emergency department (ER), KCCC, as well as SPC at home. Implementation and test of a tool to assess frailty in older patients have started. In addition planning of a pilot project, where a digital joint meeting with patient, SPC at home and KCCC, in order to integrate decisions and goals-of-care, are ongoing. The first descriptive baseline data, indicate an underreporting of quality indicators at EOL and a lack of awareness and knowledge of palliative care, among both nurses and physicians. The majority of patients with cancer that visits ER, are in a palliative phase, thus there is a need for collaboration between ER, KCC and SPC. Another finding during the first quarter of this project is that goals-of-care needs to be person-centred and integrated between caregivers. Further results of this ongoing project will be reported, alongside with a description of challenges and barriers for integration. Preliminary results highlights both educational needs, and need for further integration, to improve quality of care, in all stages of the cancer care trajectory.