Authors (including presenting author) :
Chan CO, Lam KY
Affiliation :
Department of Rehabilitation and Extended Care, TWGHs Wong Tai Sin Hospital
Introduction :
Palliative care (PC) has growing importance in care for patients and families with severe life-threatening illnesses, in terms of symptom management, psycho-socio-spiritual support, end-of-life care, and bereavement support.
A new cluster-based multi-disciplinary team consisting PC doctors, PC nurses and medical social workers (MSW) was launched in September 2020 in responding to the service gaps in PC in KCC, for 3 actions:
1) New multi-disciplinary PC specialist in-patient consultation in Kwong Wah Hospital (KWH) and Kowloon Hospital (KH);
2) New multi-disciplinary PC specialist out-patient clinic (SOPC) in KWH and TWGHs Wong Tai Sin Hospital (WTSH); and
3) Enhancement to KCC PC home care service
Objectives :
To review the service delivery, patient characteristics and interventions of the program.
Methodology :
A retrospective data capture and analysis of service deliverables, patient characteristics and interventions of the first 3 years of program (from 21 September 2020 to 30 September 2023) were done, with extracted findings reported.
Result & Outcome :
For PC in-patient consultation, 1381 new patients were reached with a total of 3767 visits. The mean waiting time was 0.53 working days(median 1 day). The median duration of first visit until discharge, transfer or death was only 3 days, which signified a narrow window for prompt PC input, and importance of our rapid response. The mean age patients was 76(range 18-108). Majority of patients had cancer(83%) and or end-staged renal failure(12%). Pain(55%), sleep disturbance(38%), anorexia(33%), dyspnea(31%), edema(30%) and fatigue(29%) were prevalent symptoms. Caregiver stress(27%) and bereavement risks(23%) were common. Wish to hasten death, wish for euthanasia and/or suicidal thoughts were reported in 8% of patients, which psychological or psychiatric input were warranted. Introduction of PC service(89%), psychological support(98%), advance care planning(72%), and discussion on care issues(71%) were mostly delivered. The commonest treatment suggestions were analgesic titration(51%) and drug simplification(57%). Care coordination was universally provided. For patient destination, 25% of patients deceased within the same hospital admission, 29% were directly transferred to PC units, and 20% were discharged. PC SOPC was offered to discharged patients as appropriate. For SOPC, 415 new patients were seen with a median waiting time of 4 weeks. Bereavement support was provided by PC MSW to selected patient-cases who deceased in non-PC settings. In conclusion, the program provided timely and valuable PC service to patients and families in need.
