Authors (including presenting author) :
Tsang KW(1), Sim PYJ(2), Au HY(1), Wong CY(1), Chan KY(1)
Affiliation :
(1) Palliative Medical Unit, Grantham Hospital, (2) Division of hematology, Department of Medicine, Queen Mary Hospital
Introduction :
There is emerging need for palliative care (PC) services in transplant recipients. We inaugurated a multicomponent intervention - the Serious Illness Care Programme (SICP), to improve care for patients with hematopoietic stem cell transplantation (HSCT) with PC needs.
Objectives :
To evaluate the impact of SICP on 1) rates of documentation of goals of care (GOC); 2) patient/family satisfaction; 3) acute healthcare service use including number of readmissions, total length of stay (LOS) in days, acute hospital death and intensive care unit (ICU) admissions, when compared those without SICP.
Methodology :
We retrospectively reviewed the outcomes of patients with HSCT and received SICP during the period of January 2017 to December 2021. Patients who were expected to die within one year were referred to the SICP. Patient who died within the same day of SICP referral or < 18 years of age were excluded from analysis. Our SICP program comprised regular inpatient consultation with SICP (3-4 sessions and 30-60 min each. Nurses who had received formal communication skills training, coaching, and system supports (e.g., e-mail reminder) conducted discussions their patients using a SICP Guide. A maximum of 2 patients per week were identified and prepared to have the SICP conversation. Patients matched for disease status and patient characteristics but did not receive SICP were selected as control in 1:2 ratio. Multivariate analyses were used to assess the impact of SICP on the outcomes of interest.
Result & Outcome :
99 patients (29 received the SICP and 70 were matched-controls) were included. 69% received HSCT for treatment of leukaemia. Mean age of SICP was 54.6 (35-71) years. GOC documentation increased from 21% to 93% in patients who had received SICP. Majority (>90 %) of the patients and their families were highly satisfied with the program. When compared with control group, the SICP group had significant reduction in total LOS (by 41%), acute hospital death (by 56%) and ICU admission (by 21%) in the last 90 days before death. In conclusion, SICP implementation resulted in high rates of documentation of GOC and preferences, high satisfaction level and reduction in acute healthcare utilization. Our model of SICP can be further promulgated to solid organ transplant recipients with PC needs.
