Marie Curie Hospice

<h3>Background</h3> The NHS Long Term Plan prioritises moving care into the community to reduce pressure on hospitals. Palliative care virtual wards and domiciliary visits (DVs) are increasingly used to support patients who might otherwise require hospital or hospice admission. Evidence shows that home-based palliative care reduces hospital use and costs; however, limited data describe the frequency and nature of DVs for people requiring specialist palliative care at home. <h3>Aim</h3> This service evaluation examined the nature and frequency of medical DVs for people receiving specialist palliative care at home in the North West of England. <h3>Methods</h3> A retrospective review was undertaken of all medical DVs recorded from a specialist palliative care inpatient unit in the North West over a three-month period. Data were extracted from electronic healthcare records, including: 1. Multidisciplinary Team (MDT) involvement 2. Interventions (e.g. symptom management, medication review, advance care planning) 3. Outcomes (e.g. referrals, admission avoidance) <h3>Results</h3> A total of 114 DVs were completed for 79 patients, with a mean response time of 1.35 days from referral to review. Joint visits with the hospice palliative care MDT occurred in 11% of cases, and 39% involved external allied health professionals. Common interventions included symptom advice and medication review. Advance care planning was discussed in one third of visits. One in four visits resulted in referrals to hospital or community services. Hospital or hospice admission were estimated to have been avoided in 26% of visits. <h3>Conclusion</h3> Medical DVs were successfully integrated into specialist community palliative care, enabling timely holistic care at home and reducing unplanned admissions. Based on published estimates of avoided hospital days, these visits potentially saved the NHS around £125,000 over three months. Further evaluation is needed to assess the wider community impact of DVs.

<h3>Introduction</h3> Bradford’s Marie Curie REACT service provides specialist palliative medicine in-reach into the Emergency Department to identify palliative patients and offer an alternative to an acute hospital admission where appropriate. 40% of patients seen by REACT in the Emergency Department are then admitted acutely. <h3>Aims</h3> This audit examines the reason for their admission and its outcome, with the Aim of informing discussions with patients regarding the outcomes of acute hospital admissions in this patient group. <h3>Methods</h3> Audit of records of 208 patients seen by REACT and admitted to hospital between June 2024 and May 2025. <h3>Results</h3> - 36% of patients died during their hospital admission following REACT review - 42% died after their admission, 23% were alive as of the date of analysis - Those with a cancer diagnosis and the 85+ age-group were more likely to survive to discharge - 39% of patients were admitted for treatment with the expectation of discharge –11% of these died during the admission - 19% of patients were admitted for a trial of treatment where the outcome was guarded – 52.5% died in hospital. 42.5% died after discharge, with 94% dying within 12 weeks. Only 5% of this sub-group were still alive at analysis. <h3>Conclusion</h3> Patients seen by REACT and admitted to hospital have a 1 in 3 chance of dying during admission. This rises to 1 in 2 for patients admitted for a trial of treatment; for those who improve with treatment over 90% die within 12 weeks. <h3>Impact</h3> This data quantifies what patients and their families can expect from an admission for trial of treatment. It informs honest and open discussions about prognosis to support patients to be cared for in their preferred location and to focus treatment on what matters most.

Treatment-resistant depression (TRD) is a common phenomenon and a considerable clinical challenge; recently, esketamine in conjunction with an oral antidepressant (AD) has emerged as a potential treatment for TRD. Several studies have shown the efficacy of esketamine in improving depressive symptoms. This prospective study aims to explore the long-term effects of esketamine therapy on subjective quality of life (QoL) and general status of adults with TRD. The study was an observational, prospective and multicenter study comprising a total of 18 TRD patients treated with Esketamine-Nasal Spray ESK-NS. Anamnestic data and psychometric assessments were collected at baseline (T0) and at follow-ups at 1 month (T1), 3 months (T2), and 6 months (T3). Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF), Sheehan Disability Scale (SDS), and Personal and Social Performance Scale (PSP) showed a statistically significant amelioration in QoL and functioning for all 3 scales, with progressive improvements at 1, 3, and 6 months. Montgomery-Asberg Depression Rating Scale (MADRS) scores decreased from a baseline score of 39.2 to 28.7 on T1, 20.9 on T2, and 15.9 on T3, respectively. Correlation analyses showed statistical significance between changes at 6 months between MADRS and QLES and between MADRS and SDS, but not between MADRS and PSP. Significant improvement in QoL was observed among patients with TRD treated with ESK-NS; ESK-NS in combination with an oral AD appears to offer meaningful benefit as a treatment option for patients with TRD who generally have substantial QoL and functioning limitations as a result of their depressive illness.

a:2:{s:4:"lang";s:2:"en";s:7:"content";s:2408:"<h3>Background</h3> In 2023, 46% of people in Scotland died in hospital settings, 4,014 in the Lothians (National Records of Scotland. Vital Events reference tables 2023. 2024 July 30 [internet]). Many people wish to be cared for and/or die at home (Johansson, Pask, Goodrich, et al. Time to care: findings from a nationally representative survey of experiences at the end of life in England and Wales. Marie Curie; 2024) and admissions close to end-of-life may even cause harm (Davies, Booker, Ives, et al. Palliat Med. 2024;38(8):806-817). Marie Curie Enhanced Hospice Care at Home (EHC{at}H) was launched May 2024 with financial support from the Scottish Government to support complex, unstable palliative patients to be cared for at home. EHC{at}H provides short-term access to 24/7 support in a patient’s home (including care home). The service is staffed by a team of nurses and medics with access to allied health professionals and other specialised support. <h3>Aims</h3> Reduce unnecessary acute admissions and facilitate acute discharge at end of life. Provide responsive palliative care for patients, families and carers with complex physical and psychological needs in their homes. Support patients to achieve their preferred place of care. <h3>Methods</h3> Initial mapping of service need and gap in existing provisions. Development of 7-day, 24 hr service providing scheduled and unscheduled support. Qualitative and quantitative evaluation embedded from service initiation. <h3>Results</h3> Year 1 annualised as of March 2025 projected 218 admissions avoided, saving an estimated £1,077,480. Supported discharge from acute setting for those previously too symptomatic. Supported preferred place of care and death. Average return on investment: 74%. Overwhelmingly positive feedback highlighting practical and emotional impact for service users. <h3>Conclusion</h3> The service launched successfully and is having a profound impact on patients and those close to them. Service figures suggest a strong return on investment, significant avoidance of acute admissions, and subsequent bed days saved. Service users with urgent palliative need can stay at home for comprehensive, tailored treatment and emotional support. Because of this, patients and those supporting them feel relieved, more able to cope and able to remain at home. ";}

<h3>Background</h3> Delirium is a serious and distressing condition, which commonly affects people with life-limiting illness. It often goes undiagnosed and hence under-treated (Woodhouse, Siddiqi, Boland, et al. BMJ Support Palliat Care. 2022;12(2):187-190). We sought to implement a range of initiatives to improve delirium care in two hospice inpatient units. <h3>Aim</h3> To assess the impact of implementing initiatives to improve delirium practice in two hospice inpatient units. <h3>Method</h3> At baseline, we conducted a case note audit and administered an online anonymous questionnaire to multidisciplinary hospice staff. Next, a range of initiatives were developed and implemented, including (i) brief ad hoc onsite staff training; (ii) educational videos for staff and carers (iii) a delirium education PowerPoint resource; as well as (iv) ongoing engagement with service managers. After a 12-month intervention period, case notes were re-audited, and the questionnaire redistributed, to explore whether the activities undertaken had improved delirium practice. <h3>Results</h3> Based on an audit of case notes (N=200), screening for delirium using a validated tool increased from 25% at baseline, to 49% after the intervention. Similarly, the proportion of patients judged retrospectively as having delirium, who had the term ‘delirium’ documented in their case notes increased from 34% to 58%. Fewer staff completed the questionnaire at follow-up (N=19 compared to N=45 at baseline), however, responses indicated improvements in self-reported understanding and management of delirium. 79% of respondents agreed they had received adequate training in delirium at follow-up (compared to 41% at baseline). <h3>Conclusion</h3> Brief training initiatives were linked with improvements in delirium practice over a 12-month period. Despite increases in delirium assessment, delirium was not routinely documented in case notes at follow-up. Self-reported improvements in delirium knowledge and skills were not always demonstrated in clinical practice. Further initiatives are required to embed delirium guidelines and evidence into routine practice.

<h3>Background</h3> In palliative contexts antibiotics are important when considering symptom control and maintaining quality of life during infections (Radbruch, Pestinger, Muller, et al. Eur J Palliat Care. 2006;13(1):5-9). In this context, parenteral access can be challenging (Roubaud-Baudron, Forestier, Fraisse, et al. Age Ageing. 2017;46(1):151-155). The subcutaneous route [SC] is a promising alternative offering ease-of-use and fewer serious complications. <h3>Aims</h3> To review the current literature on the use of SC antibiotics in palliative care, and to examine the use of SC antibiotics at the inpatient unit, Marie Curie Hospice, Cardiff and the Vale to explore tolerability and effectiveness of antibiotics via this route. <h3>Methods</h3> An electronic search of four databases was conducted to find published articles based on SC delivery of antibiotics. Electronic patient records were analysed to isolate patients that had received SC antibiotics. Patient data was anonymised, and key trends were analysed including patient factors, antibiotic factors, adverse reactions [ARs] and clinical resolution. <h3>Results</h3> 21 articles were analysed. Overall, SC antibiotics were well tolerated across the literature. Commonly reported local ARs included pain, erythema, and oedema (Jumpertz, Guilhaumou, Million, et al. J Antimicrob Chemother. 2023;78(1):1-7). No serious ARs were documented in any of the included primary research articles. Regarding pharmacokinetic [PK] profiles, SC antibiotics took longer to reach maximum concentration compared to IV. However, SC antibiotics often spent longer above MIC compared to IV, this is beneficial for ‘time-dependent’ antibiotics, such as β-lactams (Hernández-Ruiz, Forestier, Gavazzi, et al. J Am Med Dir Assoc. 2021;22(1):50-55.e6). Seven patients with suspected infection who had received a course of SC antibiotics (Tazocin (86%) and Ertapenem (14%)) were included. Only 1 of 7 patients (14%) experienced local ARs of pain and oedema. No serious ARs were reported. Resolution of infection was documented in 3 of 7 patients (43%). <h3>Conclusion</h3> The SC route offers a promising alternative method for delivering ‘time-dependent’ antibiotic therapies. It is well tolerated with few serious ARs. PK profiles of this method may improve dosing regimens and cost-effectiveness. However, further research is required as this route is off license.

BackgroundCancers of the oesophagus and stomach are a major cause of morbidity and mortality. Research is crucial to improving outcomes. However, to maximise value and impact, areas of focus should be prioritised in partnership with patients.ObjectiveWe undertook a comprehensive analysis of UK and Ireland patient and healthcare professional (HCP) priorities for research into oesophagogastric cancers across the domains of prevention, diagnosis and staging, treatment, palliative care and survivorship.DesignA scoping exercise sourced research questions from patients and HCPs. These were consolidated and then confirmed by systematic review to represent a true research uncertainty. Research questions were scored on potential impact by an interdisciplinary group of HCPs and prioritised using a weighting derived from a patient survey.ResultsThere were 835 (395 HCP, 440 patient) respondents to the scoping (n=455) and prioritisation (n=380) surveys. Across these, 4295 suggested research uncertainties were consolidated to 92 uncertainties that were prioritised. HCP respondents represented 25 professional groups from community and hospital settings. Patient weighting changed 22.2–46.3% of priority rankings established by HCPs. All domains were represented by the 20 highest priority questions, 5 of which focused on personalising and optimally combining treatment modalities. Two other key themes related to optimising nutrition and improving quality of life during and after treatment, including in patients not cured of their cancer.ConclusionThis work highlights the impact of patient input on HCP-ranked research priorities and provides a robust list of priorities to guide funders, policymakers and researchers to support and undertake impactful research.

IntroductionGlobally, the demand for community palliative care, delivered within the home setting, is rising. Hospice support workers, also referred to as healthcare assistants, play a crucial role in providing this care, but evidence indicates they face challenges relating to inadequate training, isolation and emotional labour. This realist review aims to understand how peer support interventions can support healthcare assistants in delivering hospice care at home.Methods and analysisThe realist review will follow a five-step process to explore the research question: (1) locating existing initial programme theories, (2) searching for evidence, (3) selecting and appraising evidence, (4) extracting and organising data and (5) synthesising evidence and drawing conclusions. Comprehensive searches of academic databases (CINAHL, MEDLINE, AMED, Scopus) and grey literature sources will be conducted between November and December 2024, with no restrictions on publication date applied. Search strategies will be iteratively refined, with evidence selected based on relevance and rigour. Data will be extracted and coded using a realist logic model of analysis. The review will develop an explanatory programme theory for peer-to-peer interventions which would identify what, how, for whom, why and in what circumstances peer-to-peer interventions may support delivery of hospice care at home. It will explore the contexts, mechanisms and outcomes of these interventions using context-mechanism-outcome configurations.Ethics and disseminationEthical approval is not required as the review involves no primary data collection. This review aims to clarify research gaps, inform next stages of a wider study, policy and practice. Reporting of the findings will adhere to RAMESES publication standards for realist syntheses, ensuring transparency and rigour in reporting. Results will be disseminated through peer-reviewed publications, conference presentations and other strategies identified by the stakeholder group.PROSPERO registration numberCRD42024606133.

Objective: Oral secretion problems are common yet poorly managed in people living with MND (plwMND). A validated patient-reported outcome for measuring saliva symptoms in this patient group would facilitate better monitoring of individuals. This study aimed to assess the validity, reliability and sensitivity to change of a revised version of the clinical saliva score for MND (CSS-MNDr). Methods: Data were collected as part of a longitudinal, observational saliva management study. The CSS-MNDr, ALS Functional Rating Scale, a Global Rating of Change questionnaire and saliva-specific modified Likert scale were completed at each study visit, each of which probed the severity of saliva symptoms. Construct validity, test-retest reliability and sensitivity of the CSS-MNDr were assessed and the minimal important difference of the instrument was estimated. Results: The CSS-MNDr showed excellent test-retest reliability (intraclass correlation coefficient >0.9). Construct validity showed the CSS-MNDr performed as expected, with bulbar-onset participants scoring significantly higher than those who reported limb-onset across all visits (group mean scores). Strong correlation of total scores with the ALSFRS-R saliva question was demonstrated (−0.8), with the thick subscore correlating less well (−0.5). A minimal important difference in the range of −2.5 to −3.6 over 3 months was estimated for worsening symptoms. Conclusions: The CSS-MNDr has been validated as a reliable patient reported outcome for measuring saliva problems in plwMND. With separate scores for thick and thin secretion problems, the CSS-MNDr is the most comprehensive tool for assessing salivary problems in plwMND reported to date.

IntroductionBradford’s Marie Curie REACT provides in-reach into the Emergency Department (ED) to proactively identify patients with palliative care needs and prevent hospital admissions.AimsREACT aims to address inequity of access in Bradford, where an estimated 1000 patients die annually without access to palliative care, and to reduce the number of days spent in hospital.MethodsSenior REACT clinicians in ED assess patients and manage their palliative needs, whether returning home or being admitted. The community arm provides a short-term multi-disciplinary virtual ward to support discharge from ED and refer on to other services.ResultsAverage unplanned bed days in final year of life reduced from 38 to 18.Widened access:REACT is the first contact with any palliative service for 35% of patients.REACT caseload mirrors the age, ethnicity, deprivation and disease profiles of those who die in Bradford.Improved ED staff confidence in managing palliative care patients, improved staff wellbeing and reduced moral distress.Widened knowledge of palliative care by non specialists: improving their ability to recognise patients with palliative care needs, deliver advance care planning and seek specialist support when needed.ConclusionThe REACT model of ED in-reach with a community virtual ward has a wider impact than solely reducing hospital admissions. ED is the hub of the hospital and seeing patients from an unselected take has reduced inequity and widened access to palliative care. In addition, a visible palliative care presence has reminded colleagues from across multiple specialties of the broad reach of palliative care and the impact of good holistic assessments and advance care planning in urgent care settings.ImpactThe REACT model has the potential to be adapted and adopted in other areas depending on the needs of local population and the services available.