1597P - Improving in-hospital end-of-life care (EOLC) for oncology patients in a tertiary cancer centre

Background

Cancer is the leading cause of death in Ireland, accounting for 28.5% of all deaths in 2021. Our aging population is predicted to drive a significant increase in new cancer cases in the coming decades. As such, high quality end-of-life care (EOLC) for patients dying in the acute hospital setting is an essential part of delivering holistic care to patients with cancer and their families. This is the second audit cycle to examine the quality of EOLC in one of the largest university teaching hospitals in Ireland. The first audit cycle, during the COVID-19 pandemic, identified several shortcomings in EOLC ( ESMO 2022 : S1134).

Methods

A care of dying patients guidance document, EOLC quality checklist, and staff education huddles facilitated by the Hospital Palliative Care Team were introduced in July 2022. A second retrospective chart review of patients who died under the care of the medical oncology service between 11^th July 2022 and 30^th April 2023 was performed. Data on the quality of EOLC delivered was collected and assessed using the published Oxford Quality Indicators for mortality review. An overall score for EOLC between 1 (very poor) and 5 (excellent) was assigned to each patient. These were compared with the previously presented 2021 cohort.

Results

We identified 72 patients (41 female). The median age at death was 65 years [23-89]. The mean length of admission resulting in death was 15.2 days [0-118]. The mean quality score for EOLC was 4.0, compared to 3.5 pre-intervention. Exploration of patient wishes, and spiritual care were documented in 45.8% and 58.3% of cases respectively, compared to 24.2% and 10.6% in the initial audit. 42 patients (58.3%) had care of the dying patient documents completed. The mean quality score for EOLC for these patients was 4.6, versus 3.2 for those without the document.

Conclusions

The quality of EOLC in our organisation has improved numerically in the second audit cycle. Areas of ongoing non-compliance to the Oxford Quality Indicators include exploration of patient wishes and spiritual care. The end-of-life committee, which now includes doctors in training, is committed to continuing to address deficits in the quality of EOLC in our institution, as an ESMO Designated Centre of Integrated Oncology and Palliative Care.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.