S43 Has introduction of severity criteria improved palliative care provision for patients with idiopathic pulmonary fibrosis

Background NICE guidance states that we should ‘Offer best supportive care to people with idiopathic pulmonary fibrosis (IPF) from the point of diagnosis’. NICE Quality standards also note that people with IPF and their carers should have access to services that meet their palliative care needs, which can include both generalist and specialist care.1 In 2016 it was recognised, that since the introduction of anti-fibrotic medications, clinic consultations had become focused on tolerability of medication rather than holistic assessments. Following 6 months of time-limited palliative care consultant input; 30 minute clinic slots with a respiratory physician with a specialist interest in palliative care were introduced. IPF disease specific indicators of severity were developed to identify those requiring this input. IPF Specific Indicators of severity; FVC Ambulatory O2 LTOT Cor pulmonale Anti fibrotic therapy stopped due decline >15% decline in TLCO in 6 months Methods Clinic letters of patients with IPF who attended clinic in November 2018 (n=47) were reviewed for markers of severity using the 2016 disease specific criteria. Evidence of holistic assessment, advance care planning and referral to palliative care were analysed. Results Of the 47 patients, 17 had one or more marker of severity a quarter of which were referred to specialist palliative care (SPCT). 4 of the 5 patients with two or more markers have SPCT input. Other factors for SPCT referral were noted during the audit and included functional decline and weight loss, which are known general markers of decline. In 2018 there were 23 referrals to local hospices for patients with IPF, of which 9 died, only 1 death was in hospital. There was also an increase in holistic assessments compared to 2016 (28% from 9%). Results Conclusion Introducing IPF disease specific markers of severity, following the intervention from a SPCT consultant in 2016, along with having a respiratory consultant with a specialist interest in palliative care, has improved access to palliative care and symptom control for these patients. We also noted that patients known to SPCT are also more likely to die out of hospital. Reference NICE Clinical Guidance Clinical Guideline (CG163) Updated May 2017.