Most Proposed Topic :
Clinical Safety and Quality Service I (projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors: (including presenting author): :
Chan KY(1), Tsang KW(1), Lam WK(1), AU HY(1), Wong CY(1), Leung RCY(2), Chu MMY(3)
Affiliation: :
(1) Palliative Medical Unit, Grantham Hospital, (2) Department of Medicine, Queen Mary Hospital, (3) Department of Obstetrics and Gynaecology, Queen Mary Hospital
Introduction: :
There is an increasing number of young oncology patients (YOPs) who often have high psychosocial burden and are treated intensively till death. The Care, Coach, Consult (CCC) model of our palliative care (PC) program, pioneered in July 2023, adopted a patient-centered approach with a team of linked oncologists and nurses from medical and gynecological teams, PC physicians and a nurse consultant. The linked clinicians provided primary PC and addressed immediate needs of YOPs. Parents teams received coaching from our PC nurse consultant and would consult PC team for complicated cases. Primary PC was enhanced with targeted training.
Objectives: :
This study aimed to evaluate the impact of PC on potentially inappropriate end-of-life (IEOL) care for YOPs in a mixed primary-specialist PC model.
Methodology: :
A retrospective case-control study was conducted using an electronic medical record database. YOP was defined as patients within the age range of 18 to 60 years. The main exposure variable was the initiation of primary or specialist PC more than 30 days before death. The outcomes were measured over the last 30 days of life, using the following quality indicators for potentially IEOL : provision of chemotherapy, frequency of emergency department visits (≥2), unscheduled acute admissions (≥2), length of hospitalizations (>14 days), intensive care unit admissions (≥1) and acute hospital death. Patients scoring any of these indicators received potentially IEOL.
Result & Outcome: :
The study included 392 YOPs (127 PC: 265 non-PC) in HKWC, who were diagnosed with or treated for cancer and subsequently died in 2022 and 2023. The mean age of patients was 49.5 (9.17) years old, with 52% female. The most common types of cancer observed were breast (23%), hepatocellular carcinoma (20%), lung (15%), pancreas (13%), colon (11%) and others. After our PC program, the referral and hospice rates for EOL of YOP were increased 2.5- and 1.7-fold compared to 6 months before the program. About 25% of YOPs received primary PC only in our program. Patients provided with PC more than 30 days before death were 4 times less likely to experience potentially IEOL care (adjusted odds ratio [AOR] 0.25; 95% confidence interval [CI] 0.14 to 0.29) compared to those with non-PC or late PC (within the last 30 days). Early PC initiation (>90 days) was associated with lower odds of potential IEOL care (AOR 0.27). Our PC model, which is more sustainable, can improve referral rate and significantly reduced the likelihood of potential IEOL for YOPs.
