P-21 Service delivery and clinical care for patients with substance use known to a consultation-liaison palliative care service: a retrospective audit

<h3>Background</h3> With improvements in health care provision and increased access to Opioid Agonist Therapy (OAT), people are living longer, and we are seeing higher rates of morbidity and mortality for individuals with chronic disease and concurrent or historical substance use disorders. The interface between palliative care and addiction medicine/substance use disorders is emerging. <h3>Aim</h3> To describe service delivery and clinical care for a group of patients with substance use known to a Palliative Care Consultation Liaison Service in a quaternary teaching hospital. <h3>Methods</h3> Retrospective audit from data collected at weekly palliative care multi-disciplinary team meetings between October 2019 and September 2021. Descriptive analysis was utilised, and institutional ethics approval was obtained (138/21). <h3>Results</h3> Sixty-eight patients with a mean age of 56 years, male (n=45, 66%), principal diagnosis of malignancy (n=45, 66%) were included. Common substances included alcohol (n=27, 40%), heroin/street opioids (n=26, 38%), non-prescribed cannabis (n=25, 37%) and methamphetamines (n=22, 32%). Thirteen (19%) patients were on opioid agonist treatment with methadone (n=11) or buprenorphine (2). Teams involved in care included social work (n=56, 82%), spiritual care (n=20, 29%), psychiatry (n=16, 24%), addiction medicine (n=13, 19%) and acute pain (n=8, 12%). The following were seen among this patient group: challenges in achieving symptom control (n=22, 32%), behaviours of concern (n=16, 24%), carer distress (n=16, 24%) and reluctance about opioid/medication use (n=12, 18%). Admission outcome of death occurred for 25 (37%) patients. <h3>Conclusions and future directions</h3> Concurrent substance use can increase the complexity and needs of patients and families. Further work to develop strategies and models of care for collaboration between primary care, community and hospital-based teams is needed to enhance outcomes for this potentially complex and vulnerable population.