P56 Perfectly placed for end of life care discussions?

<h3></h3> Liver disease is the third most common cause of premature death in the UK. A common complication of decompensated liver disease is ascites, affecting approximately 10% with cirrhosis. It is estimated that 50–70% of patients go on to develop ascites in the 10 years following a diagnosis of cirrhosis. Once actively suffering with diuretic resistant ascites, mortality for this group rises to 40% survival over two years. Hudson et al suggest a median six-month survival rate for patients with refractory ascites without liver transplant. Patients with end stage decompensated chronic liver disease often suffer with diminishing quality of life, poor mental health, uncontrolled pain and suffering. Palliative care has been found to be lacking in this patient group, limiting factors such as unpredictable trajectory of disease, misconception of parallel planning, lack of time, confidence and resources are implicated. Our nurse led day case service for patients with chronic liver disease is perfectly placed to begin parallel discussions. It enables early identification of patients who required end of life care planning. We are able to initiate conversations with carers and relatives, building on this at return attendances. Our senior CNS team have undergone extensive communication training with the local hospice to improve our confidence in leading end of life discussions. Alongside we have also had training conducting respect discussions and relevant paperwork. Working with patients to actively treat their chronic liver disease, whilst putting in place supportive measures and specialist referrals at appropriate times. This work is supported through regular consultant lead MDT. For the past four years, we have three senior CNS’s who are all competent in carrying out these conversations with patients whom they have built rapport with. At any one time we have around 30 patients who are undergoing regular paracentesis and will have had end of life discussions, leading to completion of ReSPECT forms. We approach this in steps initially introducing the idea by giving leaflets, then going onto having in-depth conversations at subsequent appointments. Outcomes - More people who wanted to die at home have been supported to do so. Families and carers were more prepared, supported and knew what to expect. Improved relationships with local hospice Identification of patients requiring specialist palliative care input Reducing consultant clinic visits. Overwhelmingly positive feedback from patient carers and families.