111 Refining, re-launching and reaching: Developing specialist palliative care clinics in a district general hospital setting

<h3>Background</h3> Hospital outpatient palliative care can support symptom management, psychosocial care and ACP(1) and tends to be delivered in cancer centres. Less is known about outpatient palliative care in non-cancer centres. We describe the process of developing SPC clinics in a DGH. <h3>Methods</h3> Task and finish group set up to expand OP clinics. Literature review of SPC OP referral criteria undertaken to create up-to-date referral information. ‘Before and after’ cross-sectional review of SPC clinic data performed including numbers/type of referral, patient demographics and service outcomes. Data compared 6-month post-launch of clinic expansion with same time period year previously. <h3>Results</h3> Referral criteria developed to cover supportive care and palliative care referrals. Expansion from one Consultant-led clinic to two, cross-site with ability to deliver face-to-face and telephone consultation. Pilot relaunch with oncology and then expanded into non-malignant. Post-launch increase in referrals (43 vs 11), booked appointments (75 vs 21), number of different cancer sites in referrals (17 vs 8) and patients on curative treatment (7 vs 0) with most common primary diagnoses being colorectal cancer (12, 34%) and lung cancer (7, 16%) compared with CUP (2, 18%), duodenal cancer (2, 18%) and lung cancer (2, 18%) pre-launch. Referral reasons after launch vs before: pain management (86% vs 82%), other symptoms (40% vs 55%), chronic pain following cancer treatment (5% vs 0%). Outcomes included increase in prescribing advice (45% vs 5%) and liaison with oncology (75% vs 48%). <h3>Conclusion</h3> Relaunch and expansion of SPC DGH Outpatient clinics have resulted in increased referrals (including supportive care) and range of cancer sites seen with proportionally more prescribing advice given and oncology liaison. Future need to encourage referral of patients with non-malignant conditions. Further plans to develop embedded SPC/oncology hot clinics and CNS-led ACP clinics. However, challenges to this include space/staff availability.