Access to palliative care for patients with advanced cancer: A longitudinal population analysis

Background The UK National Health Service is striving to improve access to palliative care for patients with advanced cancer however limited information exists on the level of palliative care support currently provided in the UK. We aimed to establish the duration and intensity of palliative care received by patients with advanced cancer and identify which cancer patients are missing out. Methods Retrospective cancer registry, primary care and secondary care data were obtained and linked for 2474 patients who died of cancer between 2010 and 2012 within a large metropolitan UK city. Associations between the type, duration, and amount of palliative care by demographic characteristics, cancer type, and therapies received were assessed using Chi-squared, Mann-Whitney or Kruskal-Wallis tests. Multinomial multivariate logistic regression was used to assess the odds of receiving community and/or hospital palliative care compared to no palliative care by demographic characteristics, cancer type, and therapies received. Results Overall 64.6% of patients received palliative care. The average palliative care input was two contacts over six weeks. Community palliative care was associated with more palliative care events (p<0.001) for a longer duration (p<0.001). Patients were less likely to receive palliative care if they were: male (p = 0.002), aged 80 years or over (p<0.05), diagnosed with lung cancer (p<0.05), had not received an opioid prescription (p<0.001), or had not received chemotherapy (p<0.001). Patients given radiotherapy were more likely to receive community only palliative care compared to no palliative care (Odds Ratio = 1.49, 95% Confidence Interval = 1.16–1.90). Conclusion Timely supportive care for cancer patients is advocated but these results suggest that older patients and those who do not receive anti-cancer treatment or opioid analgesics miss out. These patients should be targeted for assessment to identify unmet needs which could benefit from palliative care input

Assessment of Fatigue after Blood Transfusion in Palliative Care Patients: A Feasibility Study

Background: Blood transfusions are often used as a potential treatment for cancer-related fatigue in anaemic palliative care patients. However, evidence of benefit using validated outcomes measures is lacking.Aim: The aim of this study was to test the feasibility of using two such tools; the Brief Fatigue Inventory and FACT F-fatigue subscale, to measure change in fatigue following a blood transfusion.Method: Anemic cancer patients receiving specialist palliative care and undergoing transfusion for fatigue, completed the tools pre- and 3 days post-transfusion.Results: Thirty patients with cancer-related fatigue who received a blood transfusion completed the study. Both measures were capable of detecting statistical and clinically significant change in fatigue following transfusion. Furthermore, the measures showed significant differences between patients that did, or did not, report an overall improvement in fatigue. Patients found the measures easy to complete with no preference for one over another. Future clinical trials of blood transfusion for the management of fatigue should incorporate these validated outcome measures

Therapies received by palliative care provision.

<p>Therapies received by palliative care provision.</p

Demographic characteristics by palliative care provision.

<p>Demographic characteristics by palliative care provision.</p

Type and duration of cancer by palliative care provision.

<p>Type and duration of cancer by palliative care provision.</p

Odds ratios (95% confidence intervals) from multinomial multivariable logistic regression comparing sources of palliative care, compared with no palliative care, by patient characteristics.

<p>Odds ratios (95% confidence intervals) from multinomial multivariable logistic regression comparing sources of palliative care, compared with no palliative care, by patient characteristics.</p

Eye donation in palliative and hospice care settings: patient views and missed opportunities: Findings from the Eye Donation from Palliative and Hospice care contexts: investigating Potential, Practice, Preference and Perceptions (EDiPPPP) study

Background: there is a global shortage of donated eye tissue for use in sight saving and sight restoring operations such as corneal transplantation. Patients who die in palliative and hospice care settings could potentially donate eye tissue, however the option of eye donation is not routinely raised in end of life planning discussions as health care providers (HCP) are very reluctant to discuss eye donation as they perceive it as something that will distress patients and family members. Aims: this presentation will share findings regarding the views of patients and carers, including: their feelings and thoughts about the option of eye donation being raised with them, who they think should raise this issue, when this option should be discussed and who should be included in the discussion.Results: findings are drawn from the NIHR funded national study: Eye Donation from Palliative and Hospice care contexts: investigating Potential, Practice, Preference and Perceptions taking place in three palliative care and three hospice care settings across England (EDiPPPP)and the global literature. In view of data from the Royal National Institute of Blind (RNIB) reporting that over two million people in the UK are living with sight loss and their prediction that this figure will double to nearly four million by 2050 it is imperative that anyone who could be, and would want to donate the gift of sight is offered the opportunity to do so, especially as they approach their end of life. <br/

Eye donation in hospice and hospital palliative care settings: perceptions, practice, and service development needs – findings from a national survey

Objectives: new routes for supply of eye tissue are needed in the UK to support transplant surgery and medical research. Hospice care (HC) and Hospital-based Palliative care (HPC) services represent potential supply routes. This paper reports findings from the survey arm of the Eye Donation from Palliative and Hospice Care–Investigating potential, practice preference and perceptions study (EDiPPPP), objectives of which were to: i) Investigate existing practice in relation to eye donation across HC and HPC settings; ii) identify perceptions of HCPs toward embedding eye donation into routine end of life care planning; iii) investigate the informational, training, or support needs of clinicians regarding eye donation. Design: online survey of UK-based HC and HPC clinicians, distributed through professional organisations (Association of Palliative Medicine (UK); Hospice UK).Participants: one hundred fifty-six participants completed (63% HC; 37% HPC—8% response rate, of n = 1894 approached).Results: majority of participants (63%, n = 99) supported raising eye donation (ED) with patients and families and agreed that ED should be discussed routinely with eligible patients. However, 72%, (n = 95) indicated that staff within their clinical setting did not routinely discuss the option of ED in end-of-life care planning conversations with the majority of participants reporting that the option of ED was not ‘routinely discussed in multi-disciplinary team or other meetings.Conclusions: despite significant support, ED is not part of routine practice. Attention to barriers to embedding ED and reducing knowledge deficits are urgently needed to increase the supply of eye tissue for use in transplant operations

The potential for eye donation from hospice and palliative care settings in England: a retrospective case note review of deceased patient records

Background/Objectives: there is a need to identify additional routes of supply for ophthalmic tissue in the UK. This paper reports the findings from a national study exploring the potential for eye donation (ED) from three Hospice Care (HC) and three Hospital Palliative Care Services (HPC) in England. The objectives addressed in this paper are i.) to establish the size and describe the clinical characteristics of the potential eye donor population across six clinical sites; ii.) to identify challenges for clinicians in applying the standard ED criteria for assessing patient eligibility. Subjects/Methods: retrospective assessment of 1199 deceased patient case notes, 601 Hospice Care and 598 Hospital Palliative Care services, against current eye donation criteria. Clinicians’ assessments were then evaluated against the same criteria. by specialists based at the National Health Service Blood and Transplant Tissue Services division (NHSBT-TS). Results of the assessment and evaluation are reported as descriptive statistics (numerical data). Free-text comment boxes facilitated clarification and/or justification of review and evaluation decisions. Results: 46% (n=553) of 1199 deceased patients’ notes were agreed as eligible for eye donation (Hospice care settings = 56% (n=337); Palliative care settings = 36% (n=216). For all eligible cases (n=553) the option of ED was recorded as being raised with family members in only 14 cases (3%). Conclusions: significant potential exists for eye donation from the clinical sites in this study. This potential is not currently being realised. <br/