122 Combined palliative medicine and interstitial lung disease outpatient clinic: a service evaluation

<h3>Background</h3> Patients with Interstitial Lung Disease (ILD) experience significant symptoms at the end of life.¹ Early palliative care involvement can improve symptom control.^{2 3} Since 2016, an embedded Palliative Medicine outpatient clinic has been part of the ILD service at the Royal Victoria Infirmary, Newcastle. This service evaluation aimed to quantify the number of patients being reviewed in this clinic, to gather data on symptoms, onward referrals and subsequent outcomes. <h3>Method</h3> A single data collector reviewed the case notes of all patients seen in the Palliative Care/ILD clinic between August 2022 and July 2023. For each patient, a staff reported Integrated Palliative care Outcome Scale (IPOS) tool was retrospectively completed. Local clinical governance approval for this project was granted. <h3>Results</h3> Patients: There were 35 patient contacts over the 11 month period. Most patients (37.1%) were referred by respiratory doctors for breathlessness management (42.8%) and advance care planning (25.7%). Symptoms: 81.2% of patients were ‘severely’ or ‘overwhelmingly’ affected by breathlessness. 40.6% of patients were worried about their illness ‘most of the time’. Outcomes: 71.9% of patient contacts resulted in referrals to other teams, 53% involved advance care planning and 40.6% resulted in medication changes. Mortality three months after clinic review was 31%, increasing to 66.7% at six months. <h3>Conclusions</h3> To conclude, patients are referred to the embedded palliative care service at a late stage of illness, often with significant physical and psychological symptoms. Despite access to other palliative care support, we conducted advanced care planning in over half of contacts and sent new onward referrals from clinic. We highlight an ongoing need for the joint ILD/palliative care service in assisting patients who may have otherwise not accessed the available support. In addition, we intend to introduce patient reported outcome measures to the clinic to make reviews more patient-centred. <h3>References</h3> Palmer E, <i>et al</i>. ‘Critically examining the experience of end of life care for people with interstitial lung disease: views of patient, families and healthcare professionals’. <i>Supportive and Palliative Care</i> 2022;<b>12</b>(Suppl 2). Zou RH, <i>et al</i>. ‘The Role of Palliative Care in Reducing Symptoms and Improving Quality of Life for Patients with Idiopathic Pulmonary Fibrosis: A Review’. <i>Pulmonary Therapy</i> 2020;<b>6</b>(1). Palmer E, <i>et al</i>. ‘Which factors influence the quality of end-of-life care in interstitial lung disease? A systematic review with narrative synthesis’. <i>Palliative Medicine</i> 2021;<b>36</b>(2).