118 Perceptions of a supportive care service: overcoming referral barriers to palliative input in advanced non-malignant conditions

<h3>Introduction</h3> People with advanced non-malignant conditions experience significant symptom burden, comparable to that of advanced cancer. Despite this, only 20% are referred to specialist palliative care. Various referral barriers exist, including lack of understanding of the role of specialist palliative care, uncertainty around trajectory and prognosis and distrust in specialist palliative care continuing appropriate medical management. <h3>Methods</h3> To redress the inequity of access to specialist palliative care for patients with cardiac, respiratory, hepatic and renal failure, we established a novel ‘Supportive Care’ Service. The key elements of the service are integrated cross boundary care delivered in both community and inpatient settings and co-specialty multidisciplinary team meetings where referrals, management plans and patient progress are discussed. We then evaluated healthcare professional perceptions of the Supportive Care Service. A bespoke survey was developed including a mixture of Likert scale questions and free text comments. <h3>Results</h3> There was an overwhelmingly positive response from referrers with an average rating of 9.54/10 and response rate of 70% (26/37). Referrers reported reduced referral barriers, improved medical management and acknowledged the positive impact of the Supportive Care Service on improving patients’ quality of life. Qualitatively main themes emerged around referral to Supportive Care Service: the change in terminology to ‘supportive’ care and the co-specialty multidisciplinary approach. <h3>Conclusion</h3> The introduction of a novel Supportive Care Service successfully addresses referral barriers to specialist palliative care among health care professionals caring for patients with advanced non-malignant conditions. This appears to have been achieved through: firstly, naming the service ‘supportive’ care, which facilitates discussion and acceptance of early palliative support for both patients and professionals; Additionally, the co-specialty approach allows integrated palliative and medical management, maintenance of relationships between referring teams and patients, inter-disciplinary learning and joint multi-disciplinary team discussions that helps to mitigate uncertainty in referral suitability.