Enhanced Supportive Care (ESC)

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Purpose

To offer a new service to patients diagnosed with incurable upper gastro-intestinal cancers, delivering a proactive palliative care style of patient centred care earlier. Palliative care can improve symptom control, quality of life and ensure patients’ priorities and preferences are met. This may also impact on interactions health care services, particularly towards the very end of life.

Problem

Patients are often referred to palliative care at a stage when they are rapidly deteriorating and prognosis is short, meaning they receive a reactive service and have limited opportunity to benefit. The term ‘palliative care’ and its association with death for both professionals and patients, deters earlier referral to and engagement with the service.

Methods

This was delivered as a CQUIN. The ESC service was outpatient based and consultant led. Patients were identified through MDTs and rapidly offered assessment. Follow-up depended on needs. A questionnaire supported needs assessment. Patients were referred to other services as needed.

Results

• Patients offered ESC or palliative care review at diagnosis increased (43%-93%)
• The service was accepted by 85% of patients
• Symptom burden was high - 82% had at least one severe/overwhelming symptom at diagnosis
• On follow-up, average severity score of 11/13 symptoms had improved
• Average length of hospital stay in the last 30 days of life fell, equating to a saving of £88000 / year
• Patient/relative feedback was very positive.

Conclusion

ESC benefits patients. Fixed term funding is enabling short term expansion. Robust data collection and service analysis continue.