Analysis of an Integrated Multidisciplinary Palliative Care and Neurology ‘pal-neuro’ Service in a Model 3 Acute Hospital

Background: Previous research has demonstrated that integrated palliative care and neurology improves symptom management and the quality of life of patients with advanced neurological conditions.

 

Aims and Objectives: To evaluate the integrated ‘pal-neuro’, service (which is comprised of a monthly multidisciplinary meeting and a joint clinic) in terms of patient profile, symptom burden and interventions provided.

 

Methods: The medical notes of patients were reviewed. Demographics, referrer and primary diagnoses were recorded. Presenting symptoms and interventions delivered were coded and analysed.

 

Results: Over 4 years 31 patients were referred. 75 % were male, 25% female and the average age at the time of referral was 63 years. Patients were predominantly referred by either the local neurology (45%) or palliative care (39%) consultants. Motor neuron disease (61%) was the most prevalent diagnoses and 13% had Parkinson’s/Progressive Supranuclear Palsy. 67% were discussed at two or more multidisciplinary team meeting. 84% attended the palliative care day-care 3 or more times.

Over 90% of patients reported low mood, anxiety and mobility issues, furthermore 90% of families were distressed. Speech and swallow dysfunction were 87% and 81% respectively. Over 60% had pain, spasm, dyspnoea and dexterity issues. Interventions included physiotherapy (94%), psychological support for patient/family (84%), occupational therapy (81%), dietician (81%), ordering of equipment (74%) and speech and language therapy (71%). Medicines prescribed included antidepressants (35%), commencement/titration of Baclofen (23%), ‘as required’ opioids (26%), regular opioids (13%), benzodiazepines (16%) and 13% were administered Botox injections by the neurologist. 32% had their medications rationalised. 48% and 94% were known to Community Palliative Care and palliative care day-care, respectively.

 

Conclusion: This research describes the profile of patients referred to an integrated palliative care and neurology service and the types of interventions provided. Further research is required to explore the impact of the service on patient outcomes.