life expectancy, establishing a national strategy for care needs becomes imperative.
Aims: To estimate palliative care health care workers and service settings
needs for the brazilian population growing projection up to 2040.
Methods: Population and mortality estimates and projections were
obtained from the Instituto Brasileiro de Geografia e Estatística. Service settings were estimated from literature data.
Results: The expected increase in the Brazilian population between 2000
and 2040 is 31.5%. The minimum estimate of patients with palliative care needs was 662,065 in 2000 and 1,166,279 in 2040. Staff required for each hundred thousand inhabitants would increased from 1,734 to 2,282 and the number of nurses needed would increase from 8,586 to 11,294 in this time frame.
Conclusions: The expansion of the network for chronic and non-commu-
nicable diseases is necessary, but the qualification of existing human resources at all levels of attention to perform palliative actions can be a feasible alternative to minimize the suffering of the population.
Abstract number: P01-221 Abstract type: Poster
Using Qualitative Methods to Identify the ‘Active Ingredients’ of a Complex Intervention for Managing Clinical Uncertainty in Acute Hospital Settings
Johnson H.1, Evans C.1,2, Yi D.1, Gao W.1, Barclay S.3, Pickles A.4, Murtagh
F.5, Yorganci E.1, Wilson R.1, Higginson I.1, Koffman J.1
1Cicely Saunders Institute, King’s College London, London, United Kingdom, 2Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, United Kingdom, 3Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom, 4Clinical Trials Unit, King’s College London, London, United Kingdom, 5Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
Background: Using qualitative methods to identify ‘active ingredients’
within complex interventions can provide insight into the essential inter- vention components required to achieve intended outcomes within local settings. The AMBER Care Bundle (AMBER) is a complex intervention aimed at improving the quality of care for patients who are deteriorat- ing, near end of life, and whose situations are clinically uncertain.
Aim: To identify the active ingredients of AMBER required to benefit
patients and inform intervention implementation.
Methods: Process evaluation nested within a feasibility cluster RCT.
Focus groups with healthcare professionals, semi-structured interviews with patients and relatives, non-participant observations of multidisci- plinary team meetings (MDTs) at 2 intervention wards in 2 hospitals in England. Thematic analysis using Framework approach.
Results: 2 focus groups (26 health care professionals), 9 non-participant
observations, and 12 interviews (2 patients, 10 relatives). Active ingredi- ents included:
(i) recognising patients whose situations were clinically uncertain; (ii) engagement between patients and families and health care
professionals in decisions about care and treatment as part of daily practice;
(iii) clear documentation of current and future patient-centred treatment and care plans
(iv) implementation facilitated by a ‘champion’ to educate and sup- port staff in (i) (ii) and (iii).
Conclusions: Process evaluation is vital in unravelling the active ingredi-
ents of AMBER and the requirements for the interventions use in prac- tice. These will inform implementation of the intervention in a full trial, and the methods for wider implementation across groups and settings.
Funding: The ImproveCare - The management of clinical uncertainty in
hospital settings is funded by the National Institute for Health Research Health and Technology Assessment (NIHR HTA) programme. Project number: 15/10/17
Abstract number: P01-222 Abstract type: Poster
Feasibility of a Multi-method, Multi-centre, Cluster RCT of a Complex Intervention to Care for Hospital Patients with Clinically Uncertain Recovery: The Improvecare Study Koffman J.1, Yi D.1, Gao W.1, Barclay S.2, Pickles A.3, Murtagh F.4,
Yorganci E.1, Johnson H.1, Wilson R.1, Higginson I.1, Evans C.1,5
1King’s College London / Cicely Saunders Institute, London, United Kingdom, 2Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom, 3Clinical Trials Unit, King’s College London, London, United Kingdom, 4Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom, 5Brighton General Hospital, Sussex Community NHS Foundation Trust, Brighton, United Kingdom
Background: The AMBER care bundle was developed to support hospital
patients with uncertain recovery. Feasibility evidence is required before evaluation in a definitive trial.
Aim: To examine the feasibility of a multi-method RCT of AMBER and
optimise the trial design.
Methods: Multi-method, cluster RCT, included 4 wards in 4 hospitals in
England. Prospective, quantitative data collected at 3-time points from deteriorating patients, with uncertain recovery, and at risk of dying dur- ing admission (and their proxies). Qualitative components: semi-struc- tured interviews with patients and relatives, focus groups with health professionals and non-participant observations of ward meetings. Primary outcomes comprised: IPOS psychological subscale, and the howRwe, a patient-reported experience measure. Secondary outcomes: functional status (AKPS), EQ-5D-5L, service use data, screening, and recruitment rate. Descriptive statistical analyses and qualitative frame- work approach with subsequent integration.
Results: 22% and 5% of screened patients recruited in intervention and
control arms. Data were collected from 65 patients (51% men, 40%>80yrs, 54% non-cancer, AKPS: =31, SD=14.6). 25% died during admission and 36%⩽100 days post discharge. In both trial arms mean baseline IPOS subscale scores identified ‘moderate’ patient anxiety (=13, 95% CI 12-14), and the howRwe identified ‘good’ care experience (=13, 95% CI 12-14) with minor fluctuations at follow-up. Follow up at 10-15 days was not feasible since 37% of patients were discharged. Service use collection was feasible. Data from qualitative components identified vital improvements relating to study design including:
(i) revise inclusion criteria; (ii) comparable ward specialties;
(iii) use acute medical units as earlier recruitment start point; (iv) revise consent procedures;
(v) shorten questionnaires to minimise patient burden.
Conclusions: With refinements identified using multi-methods, an RCT
of AMBER is feasible.
Funding: NIHR HTA Abstract number: P01-223 Abstract type: Poster
Development of a United Kingdom Palliative Medicine Trainee Research Collaborative: New Knowledge through Networking Schofield G.1, Chamberlain C.2, Hancock S.3, Etkind S.4, Robbins S.5, Coop
H.6, Watson R.7, Noble S.8, Koffman J.4, on behalf of the UK Palliative
1Centre for Ethics in Medicine, Medical School, University of Bristol, Bristol, United Kingdom, 2Population Health Sciences, Medical School, University of Bristol, Bristol, United Kingdom, 3Lancaster University, Lancaster, United Kingdom, 4Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care King’s College London, London, United Kingdom, 5St Peters Hospice, Bristol, United Kingdom, 6Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom, 7St Richards Hospice, Worcester, United Kingdom, 8Cardiff University, Cardiff, United Kingdom
Background and aim: Clinical trainee collaboratives harness resource of
clinicians in training for research and multicentre audit. Well established in other medical fields in the United Kingdom, collaboratives have dem- onstrated increased trainee research exposure for trainees in research design, ethics, data collection and analysis, and manuscript preparation. National trainee collaboratives are also involved with international research projects with widespread benefits in terms of scope and reach of research outputs, skills gained and training opportunities. Until now no trainee collaborative has existed specifically for palliative medicine trainees.
Methods: The UK Palliative Care Trainee Research Collaborative (UKPRC)
was established in 2017. Modelled on other successful trainee collabora- tives, we employed the following steps:
1. Writing and adopting a constitution with shared authorship as a central tenant
2. Identifying a core group of interested trainees 3. Nominating a clinical and research lead
4. Defining a brand; logo, website, email address, newsletter, Twitter profile
5. Identifying a launch project
6. Recognising crucial stakeholders to disseminate information and garner support.
Results: Launched publicly in August 2018, the UKPRC now has active
members from 12/14 of the UK training regions. The first national audit project is underway aiming to recruit 40 sites across all sectors in the UK. The UKPRC has a website comprising 192 followers on Twitter and has been discussed in national speciality settings.
Conclusions: Collaboratives strengthen research culture and experience
amongst their members, embedding research activity and evidence- based practice from the first year of training. The UKPRC has the poten- tial to conduct research and audit across UK hospice and hospital sectors that will inform evidence-based practice and improve patient care. International collaboration with other national trainee groups globally will only increase these benefits.
Abstract number: P01-224 Abstract type: Poster
How Do Cancer Specialists (CS) and Palliative Care Specialists (PCS) Assess the Integration of Early Palliative Care (EPC) at German Comprehensive Cancer Centers (CCC)? An integrative View of Current Structures and Persistent Challenges
Seibel K.1, Bardenheuer H.2, Mayer-Steinacker R.3, Thomas M.4, Viehrig
M.5, Becker G.1
1Department of Palliative Care, University Medical Center Freiburg, Freiburg, Germany, 2Department of Anesthesiology, University Medical Center Heidelberg, Heidelberg, Germany, 3Department of Hematology and Oncology, University Medical Center Ulm, Ulm, Germany, 4Department of Oncology, University Medical Center Heidelberg, Thoraxklinik Heidelberg, Heidelberg, Germany, 5Department of Radiation Oncology, University Medical Center Tuebingen, Tuebingen, Germany
Background: Despite the growing body of clinical research regarding the
efficacy of EPC and various calls for its integration into oncological care, there is little health services research that analyses the actual EPC clini- cal practice by CS and its persistent challenges. Yet, this appears impor- tant because only the synergy of both research types can prospectively provide effective EPC.
Aims: To explore the views of CS and PCS regarding the integration of
EPC into routine cancer care in outpatient settings and their shared iden- tification of unmet challenges.
Methods: 49 qualitative expert interviews were led at 4 German CCC (39
CS from 6 specialties/10 PCS), transcribed verbatim and a qualitative content analysis was conducted.
Results: CS describe the integration of Palliative Care (PC) in their daily
routines, also in early stages, but rarely labelled it as EPC nor referred to shared standards. The results display rather a broad range of assessment and interventions.
Further, both groups identify structural restrictions and vagueness as main challenges.
Structural restrictions include e.g., time restrictions, CS’ and patients’ avoidance of EPC, the lack of a clinic-wide uniform EPC service, a partial gap in education and experience of CS, and the overlapping EPC tasks of CS/PCS resulting in intraprofessional competition.
Vagueness refers to lacking criteria for the integration of EPC vs. the need for individualised treatment, the nonexistence of a standardised EPC concept, the coexistence of various EPC models, and PC’s responsi- bility to clearly impart her EPC standards.
Conclusion: In addition to the structural factors that need to be
addressed by health policy on the meso- and macro-level, this study illustrates the continuing conceptual vagueness of EPC and the crucial need for clarification and standardisation, both within each specialty and mutually. This will provide common ground for a successful EPC inte- gration regardless of the provider.
Funding: R. Bosch Stiftung Abstract number: P01-225 Abstract type: Poster
Perception and Support for Advance Care Planning among Healthcare Professionals
Harasawa N.1, Nagae H.1, Sakai S.1, Ikeda M.1, Moriya H.1, Watanabe
K.2
1School of Nursing, Tokyo Women’s Medical University, Tokyo, Japan, 2School of Nursing, Jichi Medical University, Tochigi, Japan
Background: The healthcare professionals (HCPs; doctors, nurses, public
health nurses, pharmacists, social workers, care managers, and welfare commissioners) have a role to support advanced care planning (ACP) for citizens.
Aim: This study aimed to identify the perception and support for ACP
among HCPs.
Methods: A questionnaire included aspects of ACP, such as, whether HCPs
had ever considered ACP, if so, how they wish to share and put their ACP into action. Our study defined ACP as a preferences regarding future medi- cal care based on their life goals and personal values. The questionnaires were distributed to 1319 HCPs working in Kakegawa City in October, 2017. The data were analyzed quantitatively using Fisher test and Mann- Whitney U test. The study protocol was reviewed and approved by the Ethics Committee of the Tokyo Women’s Medical University.
Results: Nine hundred and seventy one (73.6%) completed the ques-
tionnaire. The mean (SD) age was 45.3 (14.4) years, 80.2% were women and 60.2% were nurses. Of all the participants, 60% had considered ACP, 46% had hoped to share their ACP, 34.7% actually did share, and 3.5% had the ACP in written form.
The factors related to ACP were experience of learning about EOL (p < .01), volunteer activity experience (p < .05), and had medical and care
referrals (p < .05). Those who considered ACP and actually talked about it, correlated with the number of consultations (p < .001). Eighty nine (9.2%) HCPs supported 483 clients in a month, and most of them were nurses.
Conclusion: HCPs’ own attitude toward ACP were influenced by their
education on EOL care, and having medical and care referrals. It was sug- gested that education on EOL care was necessary for professionals who play a role in supporting practice of ACP, so that they could be a good consultant to citizens.
Abstract number: P01-226 Abstract type: Poster
Non-referral to Palliative Care: An Attempt to Investigate Major Reasons
Bora S.
North East Cancer Hospital & Research Institute, Palliative Oncology, Guwahati, India Presenting author email address: sanghamitrabk@ gmail.com
Background: Cancer is an emerging public health problem in India.
Major cancer centres confirm that 2/3rd of cancer patients are incurable at presentation and need palliative care. Unequal distribution of services and few palliative care workers continue even after nationwide aware- ness and steps taken to implement palliative care. Even where services do exist, patients are referred late or not at all. Oncologists care for patients throughout their illness, but little is known of their palliative care referral practices.
Aim: To investigate the reasons for non-referral of cancer patients to pal-
liative care by oncologists in the city of Kolkata, India.
Method: A qualitative approach was adopted to explore in-depth the
experiences, practices and attitudes of 13 oncologists using semi-struc- tured interviews. The interviews were audio recorded, transcribed ver- batim and analysed using Interpretative phenomenological analysis.
Results: Key themes on reasons for non-referral are: Lack of palliative care service is about lack of palliative care service coupled with lack of knowledge
compelling oncologists to seek alternative means of extending care to their patients; Pressure to continue active treatment describes how patients and families force oncologists to continue with futile cancer treatment; Nascent
status of palliative care is about palliative care facing various teething prob-
lems; Resistance to accept palliative care as a specialty describes resistance from oncologists to accept palliative care as a new specialty.
Conclusion: The study addresses covert manifestations of non-referral
to palliative care by oncologists, the findings being consistent with sev- eral other studies. It suggests remedies to develop uniform palliative care service in the region. Considering that the patient-oncologist inter- face is a platform for palliative care information sharing, the study emphasizes the need for education and awareness for both physicians and patients for improving referrals.
Abstract number: P01-227 Abstract type: Poster
Explaining Possible Under-utilization of Palliative Care Consultation (PCC) Teams
van der Ark A., Engel M., Tamerus R., Brinkman-Stoppelenburg A., van der Heide A.
Public Health, Erasmus MC, Rotterdam, Netherlands
Background: Palliative Care Consultation (PCC) teams are involved in
only a small minority of patients with an advanced illness. Under- utilization PCC teams is suspected by stakeholders, but explanations are often not evidence-based.
Aims: This study explores which factors might influence PCC consulta-
tion by physicians.
Methods: A survey study was performed in 2017 among physicians in the
Southwest region of the Netherlands, using a random sample (n=2212) complemented by open invitation. Bivariate and logistic regression analy- ses were performed.
Results: 547 physicians participated. 85.5% were aware of the availabil-
ity of a PCC team, while 52.7% reported to consult it when necessary. In bivariate analyses the use of a PCC team was positively associated with considering palliative care advice important, ever asking colleagues for palliative care advice, use of the Surprise Question, more satisfaction with inter-organizational collaboration, higher number of patients dying per year, being a general practitioner, level of urbanity and higher age. Being a PC expert, considering inter-organizational collaboration impor- tant, having experienced inadequate information transfers and gender were not associated with use of the PCC team. In multivariate analysis, considering palliative care advice important (OR=3.4, p< 0.001), being a GP as opposed to a clinical specialist (OR =5.2, p< 0.001) and age (OR=2.0, p< 0.001) remained positively associated. Being a palliative care expert became negatively associated (OR=0.2, p=0.002).
Conclusion: About half of the physicians reported to ever consult a PCC
team. Unfamiliarity alone does not explain these results. GPs, older phy- sicians, and physicians who feel that it is important to involve experts in palliative care more often consult a PCC team than others. Efforts to increase the use of PCC teams should focus on younger physicians and clinical specialists, and increase awareness of the added value of pallia- tive care expertise.
Abstract number: P01-228 Abstract type: Poster
Evaluating Palliative Day Care Services: A Full-population Survey among Patients and their Informal Caregivers
Dierickx S.1,2, Beernaert K.1,2, Verhaert R.3, Chambaere K.1,2
1End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Gent, Belgium, 2Department of Public Health and Primary Care, Ghent University, Gent, Belgium, 3Coda Day Care Centre, Wuustwezel, Belgium
Background: Palliative day care centres remain a marginal service in the
palliative care landscape. Presently there are five such centres in Flanders, Belgium where multidisciplinary teams provide care and support for peo- ple with life-limiting conditions in a homely surrounding. Additionally, palliative day care centres support the patients’ informal caregivers by providing some time-off from informal care duties. A rigorous analysis and evaluation of the service is needed to identify the added value of palliative day care centres and opportunities for improvement.
Aim: This study aims to evaluate palliative day care services from the
perspective of patients visiting the palliative day care centres and their informal caregivers.
Method: Questionnaire survey of patients visiting palliative day care
centres and their most important informal caregivers. Data will be col- lected over a period of six months (November 2018 - April 2019) in all five palliative day care centres in Flanders, Belgium.
Results: We estimate a study population of 200 patients and 200 informal
caregivers. We will be able to present preliminary results. Sociodemographic characteristics of patients and their informal caregivers will be reported, as well as their quality of life (using the EORTC QLQ-C30) and care needs within the domains of palliative care, and to what extent their needs are met by palliative day care centres. Additionally, patients’ and informal car- egivers’ reasons, expectations and wishes related to visiting palliative day care centres and which problems they encounter in using palliative day care services will also be presented.
Conclusion: The results of this study will inform about the added value
palliative day care has for those who use it, about the direction in which to rethink or optimise the palliative day care centres’ operation and pro- vision, and about further steps in policy and financing.
Abstract number: P01-229 Abstract type: Poster