Authors (including presenting author) :
Lo HN, Ng ST, Fung MC, Tsoi FK
Affiliation :
Department of Medical & Geriatric, Hematology Unit, Princess Margaret Hospital
Introduction :
Palliative care is an approach to improve quality of life of patients and their families facing problem associated with the life-limiting illness. It is challenging in deciding when to introduce palliative care approach in Hematological patients as the ongoing therapeutic goals of curability, individual prognostication and rapid decline in terminal phase. Advance care planning is the process of decision making regarding the patient’s future medical or personal care made by consensus among healthcare team and the patient and their family, based on the best interests of the patient. Some of the hematological patients with palliative treatment receive regular transfusion and follow up in Medical Day Ward, establishment of advance care planning could be initiated in these patients during routine Day Ward visit.
Objectives :
1.To identify the potential patients who are applicable for establishment of Advanced care planning.
2.Address patient’s signs and symptoms, psychological and spiritual needs. Provide patient education on symptoms control and psychological support. Reduce frequent admission and long hospitalization stay.
3.Early refer suitable case to doctor for accomplishment of advance directive or referral to hospice care.
Methodology :
Patients with hematological illness who are mentally competent and undergoing palliative treatments were the target group of this study. Patients who receiving regular blood product transfusion, having regular follow up in medical day ward, relapsed cases and patients who have agreed DNR in advanced were also recruited. A survey was conducted among these patients in every visit to explore their physical and psychological needs. Patients signs and symptoms was monitored by the Patient Continuous Assessment Form and Palliative Performance Scale.
Result & Outcome :
During January to May 2021, total 16 potential patients was identified. The potential cases were referred to the doctor, 13 (81.2%) of the them agreed DNR. 6 (37.5%) Advanced directives were signed among the cases. All of the cases revealed that they do not noticed about the concept of advance care planning and the patient right of signing advanced directives before recruitment. Most of them believed that the establishment of advance care planning could reduce their suffering and improve their quality of life. The cases who did not agree DNR and sign advance directives, as they needed more time to think about it and discuss among relatives.
Nursing staffs in medical day ward were interviewed, all of them agreed that introduction of program helps the recruitment of potential patients to establishment of advance care planning and signing the advanced directives. Most of them agreed that the assessment tools give guidance to monitor the signs symptoms of the patients. They agreed that they feel more confident in handling the end of life issue towards patients and relatives, especially junior staff.
The introduction of the program increased the awareness of the patients about advance care planning and advanced directives. The establishment of the program give guidance for nursing staffs to recruit potential cases for advance care planning.
The positive feedback of the pilot study in day ward helps to extent the establishment of advance care planning in the hematological ward. The case recruitment tools can be modified for hematological inpatients and act as a platform for further discussion with palliative care team to facilitate the referral to palliative care service.
