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

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

 

Aim: s and Objectives: To evaluate the integrated ‘pal-resp’, service in terms of patient profile, symptom burden, interventions provided and response to same.

 

Methods: The medical notes of patients were reviewed. Demographics, referrer, primary diagnoses, co-morbidities and oxygen requirement was recorded. Change in symptom burden following interventions were analysed using the palliative care outcome collaboration programme (PCOC).

 

Results: Over 13 months 38 patients were referred. 61 % were male, 39% female and the average age at time of referral was 73 years. Patients were predominantly referred by either the local respiratory (42%) or palliative care (40%) consultants. End stage COPD (63%) was the most prevalent diagnoses and 68% were on long term oxygen therapy. 27% had cardiac failure and 18% had a cancer diagnoses. 68% were discussed at a minimum of one multidisciplinary team meeting, 46% were reviewed at more than one clinic.

 

Breathlessness, fatigue, anxiety and low mood were the most common symptoms. Interventions included optimisation of oxygen (59%), physiotherapy (51%), optimisation of inhaled therapy (38%) and 27% were referred for pulmonary rehabilitation or to occupational therapy. Medicines prescribed included ‘as required’ opioids (45%), regular opioids (40%), benzodiazepines (32%) and an antidepressant (27%). PCOC scores were significantly decreased following interventions for breathlessness and fatigue (n=15, P0.05). On presentation (94%) were in the deteriorating phase, 25% remained in the deteriorating phase and 44% entered the stable phase (n=16). 39% had their ceiling of care altered during the study period. 59% and 73% were reviewed by Community Palliative Care and Palliative Care day-care, respectively.

 

Conclusion: This research supports the efficacy of an integrated palliative care and respiratory services. It illustrates the predominant presenting symptoms and interventions provided.