Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease resulting in a range of symptoms including breathlessness.

The Westmead Breathlessness Service (WBS) is a service specialising in nonpharmacological interventions to manage breathlessness in COPD; however there is growing evidence that patients with COPD have a range of symptoms that go beyond breathlessness.

Aim: To
1) describe the physical and psychological symptom burden for patients attending the WBS.

2) examine the influence of gender on the reported symptom burden

Methods: Single-centre observational study of patients who attended the WBS between March 2017 and May 2022. We obtained baseline demographic data and symptom burden using the Condensed Memorial Symptom Assessment Scale (CM-SAS). We modified the CM-SAS by adding 2 extra physical symptoms (cough and sputum) and 1 extra psychological symptom – feeling anxious. Descriptive data were analysed using SPSS and presented as mean (SD).

Results: 89 patients aged 72.5(7.7) years, 55% male, FEV1 predicted 34(11)%. Symptom burden was high in the population. Prevalent reported physical symptoms included shortness of breath (100%), lack of energy (80%), dry mouth (70%), sputum (70%), cough and drowsiness (both 67%). Prevalent reported psychological symptoms reported included worry (65%), feeling anxious (61%) and feeling sad (51%). 

Males and females differed slightly in reported symptoms. Females reported more bothersome pain and nausea, and more frequently reported worrying, feeling nervous and anxious.

Conclusion:
Patients attending the WBS reported a wide range of non-respiratory symptoms beyond the classic COPD symptoms of breathlessness, cough and sputum. 

Although having similar baseline demographics, females reported the bothersomeness of pain and nausea, and increased frequency of psychological symptoms more often than males.

Identifying and understanding gender differences in COPD symptoms will be important in managing this symptom burden. More research is required to develop gender specific assessments and management of symptoms related to severe COPD. 

Background: COPD is a progressive, incurable, co-morbid condition that significantly affects a person’s life at the bio-psycho-social-spiritual level. Yet access to timely palliative care practices that can improve patient and caregiver outcomes across these domains can be lacking. Innovative, collaborative models of care are needed now and in the future to better support patients with COPD and their caregivers. Nurse-led supportive care was embedded in an existing nurse-led COPD outpatient model of care through a collaboration between respiratory and palliative care services at Nepean Hospital in NSW. COPD supportive care was led by an experienced palliative care nurse whose role in the COPD service was to provide specialist palliative care assessment and advice to patients. In addition, the aim was to provide mentorship and build the respiratory teams' skills, capability and confidence providing primary palliative care assessment and management. 

Aim: To explore patients and their caregivers’ experiences of a nurse-led COPD supportive care service.
Methods: As a component of a broader case study research project, semi-structured interviews were conducted with a purposive sample of patients and their caregivers (n=19) between 2020 and 2022. Data from interview transcripts were analysed using content analysis.
Findings: Preliminary findings relate to patient and caregiver experiences of: quality of life before COPD supportive care; positive effect on symptoms; openness to discussing Advance Care Planning; helpful types of support; and continuity of relationships with staff.
Conclusion: Patients and caregivers’ experiences of nurse-led COPD supportive care were overwhelmingly positive. Participants described improvements in their quality of life and illness experience, shedding light on what patients and caregivers view as valuable aspects of a supportive care approach within a chronic illness context. Understanding the experience of patients and caregivers is essential in developing services that truly meet the bio-psycho-social-spiritual needs of patients living with chronic, life limiting illness. 

SHINE: a rural palliative care patient education initiative 

 

Aim: 

Early referral to palliative care has been shown to improve outcomes. The SHINE program was developed as an information and education provision initiative targeted at a rural population.
 
  

About: 

 

Results:
 On completion, the patient feedback survey included the following: 

The program's success was confirmed through the collection of pre-and post-outcome data.  

 

Conclusion: 

Patient & carer empowerment and understanding may be enhanced in small group sessions within a rural community to improve palliative care outcomes   

 

Introduction: Models of palliative care to support dying residents in aged care homes proliferate across the country. Outcomes can be difficult to measure to indicate effectiveness.

Aim: this project aimed to assess impact of palliative care interventions from an aged care consultation team in residential aged care.

Method: over the last few years and within the staff of a community-based palliative care service, a discrete group consisting of nurses and a social worker, were designated to provide support to dying residents and their families in aged care homes. Some awareness-raising of this resource was undertaken, but most referrals came from word of mouth, when individual needs arose. A modified PCOC tool was introduced at the first visit and to guide subsequent clinical discussions with staff. 

Outcomes: In the first six months of 2022, 244 clients were visited, with 251 contacts made; all residents were seen within three days of referral and the mean length of stay was 31 days. The major presenting problem was family/carer issues; and the main physical issues were pain (both clinician and resident-rated), breathing problems and insomnia. All issues were resolved in more than 97% of presentations. Case studies will be used to illustrate the impact of these interventions.

 Conclusion: PCOC as a validated and objective tool, has assisted in measuring the impact of palliative care for dying residents in aged care homes. A discrete team has enabled the development of skilled expertise particular to older people in this setting.

Introduction:
In the last 2 years two brand new palliative care units (PCU) have been opened in the Northern Beaches Area of Sydney- one catering for adult patients receiving palliative care and a unique, Australian first facility catering for the adolescent and young adult population. Setting up such specialist facilities from scratch involves extensive planning stages, models of care discussions, recruitment, equipment and fit out work, and planning for physical opening. 

Aims:
This workshop will review many of the facets involved in the design, planning and set up of these units from multiple sources including:

Management- overarching structure, funding
Design team- practical set up, planning requirements, patient and staff needs
Medical- medical models of care, after hours coverage, upskilling in unique patient populations
Nursing- equipment, staffing, training, work instructions, particular skills in a unit embedded in an existing hospital vs a geographically isolated site
Pharmacy- planning for isolated location, drug room set up, new medications list
Physiotherapy- equipment needs, safety
Occupational Therapy- equipment needs, safety
PCOC representive- data gathering including in a unique patient population
Consumer representative- engagement in planning stages through to use of facility

There will be open discussion and reflection on what has worked well, and what in retrospect would have been approached differently.

Conclusion
As care needs rise across the population it is likely more new units will be required. We present the learnings from recent openings of two specialist units in a metropolitan area in the North of Sydney. 

As part of the Comprehensive Palliative Care in Aged Care program in South Australia, Needs Rounds have been trialled in seven private (Eldercare) and fifteen public (Rural Support Services) aged care facilities. Eldercare employed a nurse practitioner led model whilst regional sites engaged more with palliative care medical specialist, GPs and pharmacist. 

-          To evaluate Needs Rounds processes and outcomes including implementation enablers and challenges

-          To compare approaches employed by the two sites.

Methods 

Individual interviews were conducted with executive members, senior nurses, and palliative care specialists in Eldercare (n=6) and Rural Support Services (n=4). We also facilitated four focus groups with nurses, GPs and pharmacists in regional sites (n=13). Interviews and focus groups were transcribed and analysis thematically.

Needs Rounds was felt as an opportunity to enhance palliative care knowledge and practice in aged care. The educational aspect of Needs Rounds was highly acknowledged. However, sharing the learning with the broader team within the facility seemed to be more on an ad hoc basis.

Needs Rounds processes including resident identification, documentation and information sharing can be improved. An electronic system that is accessible to all staff is essential to document and share action plans and information with other staff.

Participants expressed their interest in continuing Needs Rounds beyond the life of the project. However, sustainability of medically-led Needs Rounds and GP engagement was a concern requiring long term commitment and appropriate incentive models.  

Institutionalising palliative care Needs Rounds in residential aged care contributes to improving workforce capability and palliative care practice. Characteristics of such a model depend on the context within which the model is implemented, organisational capacity, geography, and access to resources. The expansion of Needs Rounds as an effective and sustainable model requires further policy discussion at state and national levels. 

Background : Clinical Psychology is a relatively new addition to specialist Palliative Care services. In 2019, a gaps/needs analysis identified the lack of Clinical Psychology services within Illawarra Shoalhaven Local Health District (ISLHD) community palliative care as a significant service gap. A Clinical Psychology position was established in the ISLHD in January 2023 which is job shared. The ISLHD has a population over 430,000 people across 5687 square kilometres and comprises regional, rural and remote areas. There is inequity across the District to clinical psychology services.

Aim: To establish and evaluate a Clinical Psychology service to maximise patient outcomes, enhance equity and access and promote a standardised and systematic approach in identifying and responding to psychological needs of patients and to provide support to the palliative care workforce. 

Method: Determining ‘value added’ to the service will be measured using surveys, PCOC outcome data and multi-disciplinary and complex case discussions. Data about referral reasons will be collated to identify if issues of equity and access are enhanced.

Results / Findings: Recommendations for a model of care will be presented informed by patient/carer and clinician surveys, PCOC outcome data, complex case studies and referral information on patient or carer profiles.

Conclusions/Lessons Learnt: This presentation will discuss the challenges and wisdoms six months on. Entering an already established service with varying knowledge on what Clinical Psychology can add takes time. It is imperative to listen to what the patients/carers and the staff are needing from a Clinical Psychologist in this specialist community setting. It is envisaged that the Clinical Psychologist will need to be flexible in their approach (home visits, virtual or telehealth, phone consults, joint visits) and bring their comprehensive skills in assessment and formulation while also being willing engage in specific training and to learn from clients and colleagues alike.