Enhanced supportive care: prospective cohort study of oncology patients and caregivers.

OBJECTIVES: A prospective cohort study to evaluate clinical effectiveness of the enhanced supportive care (ESC) service at a comprehensive cancer centre and to explore the impact of the service on patient and caregiver outcomes and experience. METHODS: Patients who received care under the ESC service and their caregivers were eligible. Consented patients (n=184) and caregivers (n=67) completed questionnaires at baseline, 4 weeks and 8 weeks post-ESC. Patient questionnaires assessed quality of life (QOL), symptoms, experience of ESC and health service use. Caregiver questionnaires included QOL and needs assessment. Selected patients (n=13) participated in qualitative interviews. Quantitative analysis explored differences in questionnaire responses over time (p<0.05). Qualitative data were analysed thematically. RESULTS: Patient quantitative data showed improvements in QOL (p=0.004 for European Quality of Life Questionnaire 5 dimensions (EQ5D) health index scores) and anxiety (p=0.006) at 4 weeks, reduction in some symptoms (pain p=0.02 at 4 weeks), improvement in self-efficacy, an increase in problems being addressed and a decrease in health service use (reduction in outpatient appointments). Qualitative findings suggested patients were generally satisfied with the ESC service but identified areas for improvement such as increased awareness of ESC and earlier referral. Fewer improvements were noted for caregivers; however, they did report a decrease in unmet needs. CONCLUSION: The ESC service had a positive impact on various patient-reported and caregiver-reported outcomes. There were also positive impacts on health service use. Increasing awareness of ESC and engaging patients at an earlier stage in the disease trajectory may further improve patient satisfaction and outcomes.

Evidencing cost efficiencies in specialist palliative care.

In this difficult economic climate there is an increasing need in health care not only to measure improvements in quality of care but also to evidence cost efficiencies in services. Although specialist palliative care (SPC) has historically been viewed as synonymous with provision of quality care for patients, this seems unlikely to be viewed in the future as an inherent guarantee of optimum efficiency. It looks as though the SPC fraternity is going to have to quantify its value for money.

The benefits and drawbacks of syringe drivers in palliative care.

This article will outline the use of continuous subcutaneous infusion pumps, known as syringe drivers, including their benefits and drawbacks in a palliative care context. There have been over 5000 articles published globally describing syringe drivers in the medical and nursing literature within the last decade. Many provide guidance on their use, although much of the data are repetitious, disease or age-group specific, and focused on pragmatic issues to do with clinical application. Several trusts and hospices across the UK are carrying out trials of the recently launched McKinley T34 syringe driver. Therefore, it seems timely to consider their wider use internationally. Globally, practitioners in palliative care are very familiar with their use, although the literature lacks specific guidance and, at times, the information is ambiguous. Having briefly reviewed their benefits, the article considers the limitations of using syringe drivers and comments on some of the lesser known/reported practical and patient-focused drawbacks associated with their use. We conclude by considering why, when so much education and training exists to help practitioners use these devices effectively, so many human errors occur.

Extended independent nurse prescribing in palliative care.

Extended nurse prescribing is now a reality and its particular application to specialist palliative care nurses will allow them to formalize their practice of advising doctors on medication régimes and to work more autonomously. An education programme in a validated university is now operating for nurses who wish to become extended formulary nurse prescribers. Extended nurse prescribing for palliative care nurses in the community will be a particular challenge because of the large geographical areas covered, which could make communication with primary care team members difficult. If patients are to receive holistic, seamless care, palliative care nurses need to lobby for an improved, workable formulary.