Authors (including presenting author) :
Wong YYR(3), Yu LTE(10), Law MC(9), Yim KYE(4), Lee YFT(5), Lai KM(7), Ho HSE(5), Miu PL(5), Au Yeung M(5), Wong CK(6), Fan HC(6), Chan YP(5), Soong SI(2), Chow YMA(8), Kng PLC(6), So KYL(1)
Affiliation :
(1) Hong Kong East Cluster
(2) Department of Clinical Oncology, PYNEH
(3) Department of Community and Patient Resource, PYNEH
(4) Department of Medical Social Service, RTSKH
(5) Department of Medicine, PYNEH
(6) Department of Medicine & Geriatric, RTSKH
(7) Integrated Palliative Day Care Centre, HKEC
(8) The University of Hong Kong
(9) Hong Kong Society for Rehabilitation
(10) St. James’ Settlement
Introduction :
Our aging population increases demand on End of Life (EoL) care services. A medical-social collaborative (MSC) model was piloted within HKEC between clinical teams with Hong Kong Society for Rehabilitation and St. James’ Settlement in the context of the Jockey Club EoL Community Care Project (JCECC) Phase 2 project (2019-2021). The aim was to provide holistic community-based EOL care, reduce burden on hospital services as a sustainable EOL care model in Hong Kong.
Objectives :
To improve holistic EOL care using a community-based model, through a medical social collaborative care model and to assess the impact on hospital burden reduction.
Methodology :
Clinical governance was executed by a task force (TF) involving 8 clinical teams from 2 HKEC hospitals, 2 NGOs and Patient Resource Centre, supported by HKEC senior management and HAHO Primary Care Services. HKU served as coordinator and for model evaluation. The TF decided on roles and responsibilities, designed referral system with protection of confidentiality and consent. Service delivery framework was executed via “3P Care” framework - Physical, Practical & Psychosocial spiritual. A novel conjoint advance care planning workflow was piloted between geriatric clinical team and NGO to seamlessly reduce the workload for hospital team and improve engagement in the ACP. Overall aim was to improve quality of life, attain a good death and provide family support. Critical success factors were stakeholder clinical engagement, dissemination to HKEC staff, number of cases referred, service model and referral system development, characterisation of palliative care needs using the 3P framework, reduction of bed days used and emergency attendances.
Result & Outcome :
The TF convened over 20 meetings, and reported to HKEC Palliative Care Coordinating Committee, and wider engagement through 2 lunch seminars and HKEC community engagement symposium. 804 patients (geriatric, dementia, respiratory, renal, stroke, cardiac, motor neuron diseases, cancer) were referred in Jan 19- Sep 21. For a study group of 297 patients, mean age 78.3 year. 46% had cancer diagnosis, with end stage chronic disease constituting 54%. Carers were mostly spouse (49%) and children (37%), mean aged 59.1 years and they provided mean 53 hours care per week.
Measurement scores (For patients, practical concerns: 1.39/4, anxiety: 1.56/4, depression: 1.32/4, and physical symptoms: 10.65/52 as assessed with Integrated Palliative Care Outcome Scale at service intake; For carers, caregiver strain: 10.93/26, anxiety: 1.77/4, depression: 1.25/6 at service intake) showed improvement between pre and 3 months post enrolment in program, in the following 3 domains for patients (Practical Concern - ↓46.3% (N=78) Psychosocial distress - ↓28.2% (Anxiety) ↓32.3% (Depression) (N=75) and Physical Symptoms - ↓28.1(N=76). Similarly, for carers, improved measures in 2 domains are Caregiver Strain - ↓22% (N=60) and Psychosocial distress - ↓21.7% (Anxiety) ↓30.7% (Depression) (N=60)
This project for 297 patients will save 4,660 days of LOS, 39 ICU bed-days and 33 times of A&E admission.
Conclusion:
This novel MSC model for community-based EOL care improved physical symptoms, psychosocial effects and solved practical concerns for both patients and carers. Additionally, it strengthened the collaboration between clinical teams and social sector to work seamlessly for patient-centred care. It provides a sustainable model to build capacity for enabling EOL care to be appropriately delivered in community settings, and thus reducing dependency on hospital resources already overburdened by an ageing population.
