OA21.06 Turning Best Supportive Care into Active Care. A Service Development for Patients with Advanced Lung Cancer in NHS Fife, Scotland

Abstract

In South East Scotland, 40% of patients with newly-diagnosed lung cancer are unfit for anti-cancer treatment and are for ‘best supportive care’ (BSC). Many more become for BSC following palliative anti-cancer treatment or disease relapse. But there is no consensus about what constitutes BSC and who should deliver it. Patients and families are left unclear about realistic goals of care, and about what support and follow-up they can expect. Given the typically short prognosis (2012 data from NHS Fife reveals a median survival of 73 days), rapidly changing needs and high risk of hospital admission, the lack of consistency in BSC can be a serious barrier to high quality end of life care. Therefore, Fife Specialist Palliative Care have developed and piloted a model of 'proactive best supportive care' for patients with incurable lung cancer and those close to them. The new model of best supportive care was based around the following framework: *Robust identification of all patients for BSC *Comprehensive palliative care assessment and care planning *Care coordination and follow-up. Every assessment began with sensitive discussion about the lung cancer diagnosis and BSC. Detailed assessments of physical, psychological, practical and spiritual needs followed and immediate care plans were agreed. Where appropriate, anticipatory care planning was started. Structured letters were available online to all health professionals within two days. Patients were followed-up and supported for as long as they lived. 246 patients were supported by the new model of care during its first 15 months. Patients were assessed wherever they were. Most were assessed and followed-up at home or in the acute hospital, with a minority fit to attend clinic. Unnecessary outpatient appointments were cancelled. Patients and families appreciated the potential to maintain independence afforded by knowing where to access support when needed. The process of care coordination was not directly visible to them, but the quality of care it provided was deeply appreciated. Under the new model of care, patients spent significantly less time in the acute hospital before they died, with both length of stay and total bed days reduced by almost a third (comparisons with local data from 2012). A new model of proactive BSC in lung cancer has been successfully developed and piloted in NHS Fife. Patients and those close to them are now consistently supported from the point of diagnosis, with the impact of improved quality of care and more appropriate use of healthcare resources.