Specialist Palliative Care Input Research Articles

008 TRAINING IN CARDIOLOGY: IS END OF LIFE CARE BEING ADDRESSED?

Background It is widely accepted that end of life care for non-cancer conditions has lagged behind palliative care for cancer. To equip cardiologists of the future with the necessary knowledge, skills and behaviour, end of life care has been incorporated into the 2010 Cardiology Curriculum in the UK. The purpose of this survey was to evaluate the confidence of trainees in managing end of life issues in advanced heart failure patients. Methods An online questionnaire was distributed to all registrar-grade British Junior Cardiac Association members in the UK. Results The main themes from 220 respondents were: Clinical Experience: ▸ 69% of trainees experience difficulties in palliating patients with advanced heart failure. ▸ Only 54% of trainees seek specialist palliative care input when experiencing problems. ▸ 73% of trainees feel that the care that they provide patients with advanced heart failure is poor or only adequate. ▸ 70% of trainees do not routinely explain the possible future need for ICD deactivation. ▸ 84% of trainees feel that patients are better off knowing their diagnosis even if it is poor, yet more than 50% of trainees do not feel equipped to discuss advanced care planning and end of life issues when seeing advanced heart failure patients in an out-patient clinic setting. Training: ▸ 45% report receiving no training in palliation of advanced heart failure symptoms. ▸ Only 29% have received any specific training in symptom palliation of advanced heart failure at ST3 level or above. ▸ Only 17% have completed an assessment to demonstrate competencies in end of life care. ▸ 57% are unhappy with current provision of training. ▸ Over 86% think that end-of-life training is important or very important within the curriculum. ▸ In particular, trainees identify 4 key areas for specialist input: symptom control, opioid titration, communication skills and the role of the palliative care team. ▸ Trainees9 suggestions include more workplace-based supervision with additional regional and national training days, closer links with local hospices and specific fellowships for heart failure trainees in palliative care. Conclusions This survey shows that despite being part of the national curriculum for training in cardiology since 2010, trainees9 level of confidence in delivering end of life care in advanced heart failure and discussing prognosis in patients with an ICD is poor. Specific training in end-of-life care remains a neglected part of the curriculum; this could be rectified by joint training with palliative care and more formal assessment of these skills.

End-of-Life Care in Non-Cancer Illnesses

End-of-life care is that which is provided to patients experiencing a progressive final decline in their lives, usually with a prognosis of less than a year. End-of-life care in non-cancer illness may be challenging for GPs because of the uncertainty about disease trajectory. Patients with non-cancer illness often experience similar symptoms to patients with cancer but for longer hence with a greater impact on quality of life. Only a minority of such patients need specialist palliative care input so the generalist needs to be confident in assessing, treating and supporting patients and families. This article offers suggestions to overcome the challenges along with practical guidance on managing symptoms in the most common non-cancer illnesses.

Face value? Can a face-to-face specialist palliative care team at weekends add value to a tertiary centre?

BackgroundCurrent NICE Guidelines recommend that acute hospitals should provide access to face to face specialist palliative care assessments, 9 am–5 pm, 7 days per week. Continuity of specialist palliative care...

P222 Multi-Disciplinary Team Attitudes Towards End-of-Life Care in Severe COPD

IntroductionChronic obstructive pulmonary disease (COPD) is the fourth leading cause of death globally. The physical and psychological symptom burden in severe COPD is significant and yet many of these symptoms...

Care of the Dying in Australia's Busiest Hospital: Benefits of Palliative Care Consultation and Methods To Enhance Access

Hospital-based palliative care consultative teams assist with decision-making, symptom management, patient and family support, and discharge planning for those with advanced illness. However, there is evidence to suggest that many patients dying within acute hospitals receive no specialist palliative care input. This project aimed to assess care provided to patients dying within a large Australian hospital and to understand senior clinician decision-making around referral to palliative care. A multi-methods approach was taken that incorporated a literature review, a retrospective chart-audit using the Liverpool Care Pathway to assess quality of end-of-life care, and semistructured interviews with clinicians. The audit demonstrated wide variation in referral practices from clinical units, with overall only 42% of dying patients referred. A number of deficiencies in the care of dying patients within the hospital were evident; however, referral for palliative care consultation was associated with improvements in availability of appropriate end-of-life medication orders, communication with patients and families, and cessation of futile treatment and interventions. Eight themes emerged from the interviews with clinicians, including uncertainty as to the role of palliative care and a discrepancy between medical and nursing views of the utility and timing for palliative care. The findings demonstrate both the need for more frequent and/or earlier referral of dying patients and the need for generalist staff to become more skilled in the delivery of palliative care. It also highlights the need for palliative care clinicians to be educators and advocates within services to enhance care at end-of-life.