P-32 Does voluntary assisted dying impact quality palliative care? A retrospective mixed-method study

<h3>Objectives</h3> We aimed to explore the relationship between the pursuit of Voluntary Assisted Dying (VAD) and the delivery of quality palliative care in an Australian state where VAD was newly available <h3>Methods</h3> We adopted a retrospective convergent mixed-methods design to gather and interpret data from records of 141 patients who expressed an interest in and did or did not pursue VAD over two years. Findings were correlated against quality domains. <h3>Results</h3> The mean patient age was 72.4 years, with the majority male, married/partnered, with a cancer diagnosis and identifying with no religion. A third had depression, anxiety or such symptoms, half were in the deteriorating phase, two thirds required help with self-care and 83.7% reported moderate/severe symptoms. Patients sought VAD because of a desire for autonomy (68.1%), actual suffering (57.4%) [existential more than physical], fear of future suffering (51.1%) and social concerns (22.0%). VAD enquiries impacted multiple quality domains, both enhancing or impeding whole person care, family caregiving and the palliative care team. Open communication promoted adherence to therapeutic options and whole person care and allowed for timely access to palliative care. Patients sought VAD over palliative care as a solution to suffering, with the withholding of information impacting therapeutic relationships. Our analysis ascertained that patients could fall into one of three categories: those open to exploring palliative care, those who were ambivalent about palliative care and VAD and those who were committed to pursuing VAD, regardless of palliative care involvement. Exploration of the fears, uncertainties, suffering and needs of these patients and families are critical clinical tasks. Palliative care practitioners are challenged to be companions to patients on each path, regardless of outcome. <h3>Conclusions</h3> As legislation is expanded across jurisdictions, palliative care is challenged to accompany patients on their chosen path. Studies are necessary to explore how to ensure the quality of palliative care remains enhanced in those who pursue VAD and support caregivers and staff in their accompaniment of patients.