OP-34 Empowering end-of-life choices: five year evaluation of an innovative model of integrated palliative care funded by a private health insurer

<h3>Background</h3> Recognising patients‘ preferences and enabling them to die in their preferred place is a critical aspect of effective palliative care delivery. It is crucial to recognise that not all patients wish to die at home. Everyone’s end-of-life preferences are unique. Therefore, the decision about where to receive end-of-life care should be based on the patient‘s individual preferences and needs, made in consultation with healthcare providers and carers. <h3>Objectives</h3> The primary aim of this study was to evaluate whether patients in the Bupa Palliative Care Choices Program (BPCCP) at St. Vincent’s Private Hospital Brisbane (SVPHB) achieved their preferred place of death over five years. Secondary aims included assessing patient and carer satisfaction with the support provided by BPCCP in achieving these preferences. <h3>Methods</h3> This study employed a single-centre, prospective cohort design and surveyed patient and carer experiences. The study population included patients admitted to the SVPHB Community Specialist Palliative Care Service (CSPCS) from August 1, 2016, to July 31, 2021, who were eligible for BPCCP (prognosis of six months or less and were insured under Bupa Private Health Insurance). Data on the patients’ demographics, preferred place of death, and actual place of death were collected from electronic patient records. Patient and carer satisfaction was measured using the FAMCARE-2 survey, a validated tool assessing satisfaction in symptom management, information provision, family support, and psychological care. <h3>Results</h3> A total of 779 patients were admitted to BPCCP over the five-year period. The cohort had a median age of 77 years, with 50.3% male, 49.7% female. The majority (81.3%) had malignant diseases, predominantly lung cancer, while 18.7% had non-malignant conditions such as cardiovascular disease. Out of the 608 patients who died during the study period, 39.5% died at home, 40.1% in an inpatient palliative care unit, and 20.4% in an acute hospital setting. Of the 558 patients who stated a preferred place of death, the majority of BPCCP participants preferred to die at home (53%), and overall, 85.7% achieved their preference. Specifically, 79.0% of those who preferred to die at home, 91.5% who preferred to die in an inpatient palliative care unit, and 100% who preferred an acute inpatient setting achieved their goal. <h3>Discussion</h3> The study found that 85.7% of BPCCP participants died in their preferred place, indicating a high level of success in aligning end-of-life care with patient preferences. Common barriers to achieving the preferred place of death included acute medical events, active treatment requirements, carer stress, and sudden deterioration. The high satisfaction rates from the FAMCARE-2 survey highlighted the program‘s effectiveness in managing symptoms, providing information, and supporting families and caregivers. <h3>Conclusion</h3> The BPCCP demonstrated the potential to significantly improve access to high-quality palliative care and support patients in achieving their end-of-life preferences. The program‘s success underscores the importance of integrated care models and partnerships between healthcare providers and private insurers to facilitate patient-centred end-of-life care. Future research should explore similar models across different regions and settings to further validate these findings and improve palliative care delivery.