Expanding non-cancer Supportive Care
Clea Atkinson, Consultant, Cardiff and Vale University Health Board
Introduction
In Wales, 33,000 people die annually, 75% from non-cancer conditions, with 43% of all deaths in hospitals. Advanced organ failure causes similar distress as metastatic cancer, leading to frequent hospital admissions and significant avoidable interventions.
Despite palliative care improving outcomes, only 20% receive Specialist Palliative Care due to access inequality. The Cardiff and Value University Health Board Supportive Care (SC) service, initially for heart failure patients, aims to address palliative referral barriers, improve patient experience and reduce hospital time preceding end-of-life and is expanding to three further advanced conditions.
Methods
- Established trust with senior clinicians and specialty nurses from advanced liver, renal and interstitial lung disease teams and gained commitment by sharing heart failure data.
- Agreed referral criteria and set up co-speciality MDTs for joint discussion of referrals, urgency categorisation and patient-centred decision-making.
- Developed patient-centred clinics for efficient resource use and increased multi-professional input, adjusting clinic slots for patient convenience and introducing ‘hot clinic’ slots for urgent issues.
- Surveyed referrers after nine months and switched MDTs to a hybrid model for better attendance, and began sharing patient story examples.
- Engaged with C&VUHB finance and Value Based Healthcare teams for frequent evaluation of impact on admissions and bed-days, refining data evaluation methods to differentiate between disease-related and unscheduled admissions.
Outcomes
205 non-cancer patients were referred to SC over 18 months with no impact on referral rates to usual palliative care services.
96% of referrers feel the SC approach overcomes usual barriers to palliative care.
Patient-reported experience measures (PREMs) showed high satisfaction:
- 100% would recommend the service to someone else
- 100% felt the service was delivered with compassion
- 94% felt involved in decision-making
- 72% reported improved quality of life (QoL)
Patient-reported outcome measures (PROMs) – evaluated 36 clinic patients with 53% indicating improvements in their health perspectives.
Comparison of time spent in hospital in the last year of life showed reductions for SC patients versus control group resulting in 1,211 fewer hospital days over 18 months despite disease progression.
What next?
- Creation of bilingual service literature to facilitate consultations and decision-making in Welsh.
- Allied health professionals are now leading education groups for patients and carers.
- Moving towards digital PROMs tools to simplify evaluations.
- Modelling non-cancer disease trajectories and exploring novel approaches for admission avoidance.
