Existing quantitative evidence for the benefits of Hospice Day Services is limited. Clinical Commissioning Group funding decisions are often based on numbers of attendees, rather than overall impact on individuals engaging with those services. At Woodlands Hospice, an outcome measures questionnaire, the Integrated Palliative Care Outcome Scale (iPOS), was implemented on the inpatient unit several years ago, and, in addition to being clinically useful for individual patients, audit data showed an overall improvement in average iPOS score during patients' admission. The use of iPOS was piloted for new patients to our Day Services at their initial assessment from December 2018. This tool was used to assist in transforming our individual patient care plan, with a change in our practice being to repeat iPOS for each patient every four weeks to update the care plan. A baseline audit showed a mean overall improvement in patients' iPOS score when repeated after four weeks. Interventions during the four-week intervening period varied according to the patient's own personalised plan of care. The interventions ranged from solely medical outpatient review, to multidisciplinary assessment and management, with some patients attending individual outpatient sessions only, and others attending group therapy sessions. This audit looks at the breakdown in improvement of physical symptoms and psychological wellbeing, and compares the reduction in iPOS score to changes in other outcome measures, namely the OACC Phase of illness and the Palliative Performance Scale. The use of these outcome measures will enable the hospice to monitor the effect of the care and interventions it provides to each individual patient and ensure their personal care plan is continually adapted in accordance with their specific needs as their condition changes.
The benefits of exercise for people with life-limiting conditions are widely recognised. Woodlands Hospice runs a weekly exercise group which is well attended. Feedback is positive and the environment provides more than simply physical benefits. It has become a safe place that instils positivity and humour where patients can share feelings and coping strategies, gain support and strength from their peers and staff, ask for help whether physical, emotional or spiritual and where they can just 'be'.
Aim
To further develop this group to enhance the experience for patients. Specifically: Music.To introduce music in the form of a personal group playlist where all patients are involved in sharing a song and a reason for its choice. This music is played during the group and made available to take home. Tai Chi. To teach simple chair based Tai Chi to be practised at the end of each session to promote a calm and contemplative atmosphere. Palliative Outcome Scale (POS). Using this recognised tool on a monthly basis helps patients to discuss any new concerns, allows staff to signpost patients appropriately and streamlines outcomes throughout the hospice.
Methods
Literature review on clinical benefits of Music therapy and Tai Chi Consultation with group members Practise Tai Chi sessions Multidisciplinary consultation regarding introduction of POS.
Results
MusicA feeling of ownership and camaraderie promoting discussion ranging from shared memories to the spiritual needs of the present Tai ChiThis new skill has facilitated relaxation, breathing control and aided sleep POSIts use has identified a gap in care when patients are not accessing other hospice services and ensured their needs are met.
Conclusion
The exercise group has proved to be a good leveller with patients feeling confident to share experiences whilst gaining physical and emotional strength.
Woodlands Hospice has run a 'Supportive Living Programme' aiming to enable patients to live as well as they can, for as long as they can, for several years. This is a 10 week rolling programme of clinician-led sessions on varied topics relating to patient wellbeing, which is well attended and receives positive feedback. Following completion of this programme, patients are encouraged to attend an informal peer support group where they can share experiences, make friends and grow in confidence. Over time it became apparent that attendance at this group was diminishing and feedback from the patients was that they missed the clinical support they had enjoyed in the 10 week programme.
Aims
The hospice was keen to ensure ongoing appropriate support and enable patients to feel safe in the knowledge that their individual clinical needs would continue to be met by the healthcare professionals they had come to know and trust, avoiding a crisis situation or potential hospital admission.
Method
Patient feedback was reviewed and discussions held between patients and healthcare professionals following which the 'Living Support Group' was re-launched alongside a nurse-led clinic. Feedback from patients following this re-launch was then sought and attendance evaluated.
Results
Since its re-launch there has been an increase in attendance by 35% over the course of a year. Feedback from patients and carers indicates that knowing they have access to clinical support encourages them to attend and enables them to enjoy time with other patients in a peer support setting.
Conclusion
Patients find peer support, friendship and experience-sharing very beneficial to their overall wellbeing. Having individual clinical support available to them in the 'Living Support Group' encourages attendance and thereby promotes patient wellbeing in both clinical and non-clinical attributes.
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