Amanda J Brisebois
Grey Nuns Community Hospital, Canada
Title: The PPRISM clinic for non-cancer palliative care and symptom management: Addressing the needs of patients with cirrhosis
Biography
Biography: Amanda J Brisebois
Abstract
Background & Aim: Efforts are being focused on integrating palliative principles at the earlier stages of disease, and to create outpatient programs to focus on this type of integrated care.
Methods: To serve patients with cirrhosis, a non-cancer outpatient Palliative Care Clinic was formed and referral criteria were developed to make an attempt to capture patients in the last 6 months of life. ESAS-r (Edmonton system assessment scale) was attained for all the patients at each clinic visit. Data regarding their medication changes, goals of care, and stage of their disease, ER visits and hospitalizations were also recorded.
Results: In the outpatient clinic during 2013-2015, significant symptoms (score of 4 or more/10) were as follows: 70% pain, 90% fatigue, 60% drowsiness, 70% lack of appetite, 60% nausea, 40% shortness of breath, 30% depression and 40% anxiety. Patients had both compensated and de-compensated disease. KPS (Karnofsky Performance Status) average was over 60%, however, the death rate (30%) was high.
Conclusions: Analysis of the complete patient data for the initial 35 cirrhosis patients of the PPRISM clinic will be presented including information regarding referral success for various patient populations, symptom burden, goals of care documentation and follow up needs in this patient population. This study will guide future outpatient clinics by enhancing goals of care and advance care planning integration, patient and family involvement in health, and symptom care protocols for patients living with cirrhosis. A more detailed look at this data may also help future clinics to decide interdisciplinary needs of outpatients living with chronic illness.