Poster abstracts CONNECTING DIVERSITY

Poster abstracts
Poster abstracts
makers internationally with a powerful tool
408. Development of a Municipal Palliative Care
Program in the Public Health Department in
Rosario, Argentina.
Hugo Fornells 1 , Daniela MacGarrell 1 , M Alvarez 1 , A
Armando 1 , A Kalbematter 1 , M Padovani 1 , David
Willems 1 , Stella Binelli 1 , Pablo Amigo 2
1
Municipal Palliative Care Program, Department of Public
Health Sciences, Rosario, Argentina, Argentina
2
Palliative Care Program, Edmonton, Canada
Introduction: Rosario is a city in Argentina with a
million inhabitants. The municipal public health serves
300,000 people, with around 500 deaths per year due to
cancer. The Municipal Palliative Care Program was
created in 2004, consisting of the Adult Palliative Care
Unit (UCPAR), Pediatric Palliative Care Unit (UCPP) and
the Domiciliary Palliative Care Unit (UCPD). Methods:
Data from all patients admitted to the program from
2004 to 2005 was reviewed. Opioid consumption was
evaluated and compared to the year before the creation
of the program. The percentage of the palliative care
population seen, waiting time for admission to the
program, symptom control using the ESAS and home
death rate were also evaluated.Results: Opioid
consumption increased 341%, with 41.6% of the
palliative population seen by the Program. Waiting time
for admission was one day (mean). Adequate symptom
control was achieved in over 50% of the patients for
pain, dyspnea, nausea, anxiety and mood. Home visits
were provided to 41.82% of the patients, and home
death was achieved in 66% of the patients admitted to
the UCPD. Of note, 39% of the patients admitted to the
UCPAR and 100% of the patients admitted to the UCPP
died there.Conclusion: It was possible to provide
interdisciplinary palliative care services with little
waiting time, good home support and good symptom
control, increasing opioid consumption. The goals are
to increase access to the service and to extend this care
to non-cancer patients.
409. Better Late than Never? The Impact of Late
Referrals upon the provision of Community
Palliative Care
Philip Macaulay, Sylvia Spicer, Trish Sutton, Kath
Savona, Jane McGuire, Helen Vaz, Stephen Brooker
Sacred Heart, St Vincent’s Hospital, Palliative Care Centre,
Sydney, Australia
The Late Referral Project (LRP) is an initiative that
commenced at the beginning of 2006 to try to minimize
the often-stressful impact of a Late Referral to the
Community Palliative Care Team (CPCT) upon the
patient, the staff and the service as a whole. The LRP
sought to ascertain the external pathways for LR’s so that
they might be monitored and the reasons for lateness
examined. The assumption behind the LRP was that LR’s
are stressful for the staff involved, requiring complex
coordination and sometimes have a less than optimal
outcome for the patient . The aims of the LRP were to try
and improve the quality of service provided by staff, and
also the quality of support delivered to staff in difficult
and stressful situations. The LRP carried out a literature
search, a staff survey, a clinical file audit and together
made a series of practical arrangements within the
functioning of the team to deal with LR’s when they
arrive. In addition, the LRP, for the first time, collated the
results and defined a LR to a Palliative Care Service as
being “14 days from referral to death” and as”the inability
to optimally respond to the needs of the pt and family due to
the limited time available for best practice planning and
implementation prior to death.”
410. How do you persuade patients, staff and
volunteers in a successful Day Hospice attached to
an Acute In-patient Palliative Care Unit, that
service delivery processes must change to
accommodate a new economic reality?
Kate Thompson 1 , Bee-Wee Leung 2
1
Sir Michael Sobell House, Palliative care unit, Oxford,
United Kingdom
2
Sir Michael Sobell House, Palliative Medicine, Oxford,
United Kingdom
MethodFollowing staff cuts, a step-wise iterative
approach using process mapping, focus groups and
working groups identified changes which are now being
implemented. Results Process mapping identified
bottlenecks, which interfered with patient flow, and
issues of equity regarding access to complementary
therapies and recreational activities. Whilst focus groups
highlighted the supportive environment, the sense of
belonging and the safe environment, they also
identified areas for improvement. Specifically, there
were opportunities for improvement in documentation
(concerning referral criteria, expectations of placement
and discharge), equity of access and staff skill
mix. DiscussionWhilst process mapping proved to be
efficient in demonstrating bottlenecks in patient flow
and equity, the process proved a challenging experience
for the team. Although an invitation was made to all
stakeholders to join relevant focus groups, bias may have
arisen through self selection. Nevertheless, suggestions
concerning changes in patient flow, practice and equity
of access have been approved and implemented. This is
a work in progress; new approved documentation (for
referral, invitation and assessment) and a reorganisation
of service delivery will begin in January 2007. Six month
follow up outcome data will be available for
presentation at the EAPC Congress
411. Support in palliative care for general
practitioners (GPs): a telephone advisory service
project by specialised GPs in the Netherlands
(2000-2003)
Florien Heest van 1 , Ilora Finlay 2 , Renee Otter 1 , Betty
Meyboom-de Jong 3
1
Comprehensive cancer centre North-Netherlands, Palliaitve
Care, Groningen, Netherlands
2
University Medical Center Groningen, Department of
Oncology, Groningen, Netherlands
3
University Medical Center Groningen, Department of
Family Medicine, Groningen, Netherlands
Many patients with a life-threatening disease wish to die
at home.
The region covered by the Comprehensive Cancer
Centre North-Netherlands (CCCN), is a predominantly
rural area with a population of 2.1 million, about 1000
GPs, 17 hospitals and 5500 cancer deaths per year.
Access to cancer therapy and disease modifying therapy
is well organised. 61% of all patient deaths in 1998-1999
occurred at home. In 2000 the area had neither hospices
nor nurses or doctors working as specialists in palliative
care.
The aim of this project was to organise rapid access to
palliative care advice for all GPs caring for patients dying
at home. We describe a novel type of support for GPs:
the establishment and evaluation of a telephone
advisory service for GPs, run by four regional working
GPs with a Special Interest (and training) in palliative
care (GPSI).
A growing number of GPs called for advice starting with
about 100 calls in 2000 up to almost 600 in 2003; 10%
during out of hours. Calls lasted 15 minutes (mean) and
sought advice on patients of all age-groups (mean age 62
yrs, range 0-100), usually in the last phase of
illness (prognosis days - weeks in 70%). Most advice
sought concerned symptom management, discussion
revealed more other problems. On evaluation, 85 % of
the GPs followed the advice.For instance the use of
subcutaneous infusions at home tripled.
Conclusion: the advisory service seemed to fulfil a need
for support of GPs caring for patients dying at home.
412. Palliative Mobile Team in a Shelter for
Homeless People
Katalin Muszbek 1 , árpád Gajdátsy 2 , Eszter Biró 1 ,
Adrienn Thuránszky 1
1
Hungarian Hospice Foundation, Budapest, Hungary
2
Methodological Social Centre and Institutions, Budapest,
Hungary
Objective: After the fall of communism, the group of
homeless people emerged in Hungary in the wake of
radical changes in social life. This is the group in the
perhaps worst physical condition where illness is often
discovered at a highly advanced stage. The cooperation
of the Hungarian Hospice Foundation and the Budapest
Shelter for the Homeless is an effort to offer palliative
and hospice care for homeless people in the terminal
phase of their illness. Also, it seeks to change some of
the widespread confirmed attitudes of nurses towards
this highly disadvantegous group. Method: From 2004
on, members of the multi-disciplinary team of the
Hungarian Hospice Foundation visit the Shelter once a
week. Physicians, nurses, psychologists, physiotherapists
and voluntary workers offer palliative care to terminally
ill patients in an effort to preserve the dignity of life.
Once a week, we organize art therapy sessions for
outpatients of the night-shelter. We also organize
trainings for the local staff and the Foundation provides
the opportunity of field practice at the Budapest Hospice
House. Results: In the last years we nursed a total of 76
patients. 45 persons took part in the art therapy
sessions, and 10 professionals in our trainings and field
practices in the Budapest Hospice House.
Conclusions: The palliative mobile team is a new and
very effective kind of care for homeless people who
belong to the perhaps most disadvantegous group in
society. The palliative mobile team has established a
new attitude in the care of this helpless group.
413. How does proximity to a hospital/hospice
relate to place of death from cancer?
Philippa Hughes, 1 , Manisha Mistry, 2 , Peter Bath, 3 , Bill
Noble, 1
1
University of Sheffield, Academic Unit of Supportive Care,
Sheffield, United Kingdom
2
University of Sheffield, Medical School, Sheffield, United
Kingdom
3
University of Sheffield, Department of Information Studies,
Sheffield, United Kingdom
Background: The percentage of UK home deaths has
decreased with more deaths in institutions. Many factors,
including social deprivation, which may influence this,
have been reported. Aim: To examine relationships
between place of death, deprivation index, and proximity
to an institution, for cancer deaths in Sheffield, UK.
Method: For the period 1997-2002, data was collated on
deaths at home, in a hospice, or elsewhere, for the 29
Sheffield electoral wards. Deprivation indices and
standard distances from each ward to the main city
hospitals and hospice were obtained. Spearman’s rho
correlations were calculated. Result: The correlation
between home deaths and deprivation index was weak
(Spearman’s rho: 0.312) and not statistically significant
(p=0.099). There were significant negative correlations
between death at the hospice and deprivation
(Spearman’s rho:-0.697, p=0.001); and death at the
hospice and distance from it (Spearman’s rho: 0.566,
p=0.001). A weak but significant correlation was seen
between distance to hospital and death in hospital or
other institutions (Spearman’s rho:-0.398, p=0.032).
Conclusion: Our findings did not confirm a negative
correlation between death at home and deprivation
index in Sheffield, but suggest that proximity to facilities,
particularly hospice, may influence place of death. Wider
ranging study may differentiate and quantify the
influence of proximity of hospices and hospitals on place
of death.
414. ONGOING PALLIATIVE CARE IN PRIMARY
HEALTH CLINICS
Yifat Rave 1 , Sharon Wynne 2 , Rivka Golan 3
1– 3
clalit health service, Community Health Service, haifa,
Israel
Rational
Oncology patients throughout all stages of the disease
suffer from a variety of symptoms requiring palliative
care. Despite the fact that they undergo treatment in
hospital, they spend most of their time at home.Contact
with their primary health care givers is usually minimal
at this time. Patients approach the hospital staff with all
their problems. Not all oncology patients are known to
the clinic nurses therefore the nurses are not able to
meet all their needs.
Aim Improve the connection between clinic nurses and
the oncology patients. Empower the nurses in taking
care of oncology patients.
Process Nurses from community health clinics were
chosen to manage the care of oncology patients. The
nurses underwent courses in palliative care to acquire
the required skills. Computer lists of oncology patients
were sent to these nurses twice a year. The nurses
coordinate the care according to the patients’ special
needs with the primary care physician and the hospital
staff as necessary. Data on the nurses’ activities is
reported back to the Head Oncology Nurse once a year.
Conclusion This project is now carried out in all clinics
in the region. Nurses report contact with about 90% of
the oncology patients. They feel satisfied and
empowered being capable of responding to most of the
patients’ needs. It was shown possible to give ongoing
palliative care throughout all stages of the disease in the
community.
415. Consultation in palliative care; how to
improve quality?
Erica Witkamp, Mathilde Van der breggen, Pascalle
Voerman, Janneke Koningswoud, Jorien Van der doel,
Lia Van zuylen
Erasmus MC University Medical Center, Department of
Medical Oncology, rotterdam, Netherlands
Introduction
In the Netherlands the Comprehensive Cancer Centres
(CCC) organises consultation in palliative care. To
develop and improve the quality of the consultation, the
CCC of Rotterdam (CCCR) recently set up the
Committee for Quality Improvement of Consultation in
Palliative Care (the Committee).
Method
Consultants from the region ,a representative of the
CCCR and the Erasmus MC participate in the
Committee. Target is to monitor and improve the
consultation by increasing knowledge and expertise of
regional consultants and by optimizing the
organisation.
136 10th Congress of the European Association for Palliative Care, Budapest, Hungary, 7–9 June 2007