G366(P) Challenges and facilitators to joint-working and referral to paediatric palliative care: a healthcare professional perspective

Background Despite the National Institute of Clinical Excellence suggesting involvement of specialist paediatric palliative care (PPC) leads to better symptom control and ‘total care’ of patients/families for those with life-limited or life-threatening conditions, many of those eligible are not referred. Aim To explore healthcare professionals views on challenges and facilitators for referral to PPC, in a tertiary hospital with no integrated palliative care team. This research will help inform future quality improvement projects locally, to ensure more children’s palliative care needs are met. Methods Initial literature review to direct qualitative research: Medline search using terms associated with ‘healthcare professionals’, ‘paediatric palliative care’ and ‘referral’, screened for relevance. Qualitative research Focus groups (approximately 5–8 healthcare professionals sufficiently senior to refer to PPC and voluntarily consenting to take part) will be held for each department area. Departments are grouped due to clinical cross-over and to ensure appropriately sized focus groups but aim to span the full spectrum of PPC needs, including neonatal, intensive care, general and community paediatrics and neurosurgery amongst other sub-specialties. Participants’ views, knowledge and current practices around referral to PPC will be explored, through fictitious case vignettes of children with different PPC needs. Thematic analysis of recorded audio of earlier focus groups will inform approach/question style for subsequent. Differences between departments will also be compared. Results Current literature is often US-based or uses oncology/intensive care cases, therefore not generalisable to UK-based children across the spectrum of PPC needs. Twamley et al (2014) had most relevance, however, leaves a gap in examining differences between sub-specialties and suggests ‘deeply embedded attitudes’ may be the reason for discordance between understanding and referral rates. The qualitative research is currently being undertaken. We expect to present preliminary results from focus groups held from February 2020. Conclusions The researchers hope to draw themes from the focus groups. We expect some overarching themes throughout all groups but others that may be more department specific. We are interested to see how health professionals perceive palliative care needs for case vignettes that are somewhat removed from their usual caseload.