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Dying from Lung Cancer

Dying from Lung Cancer. An audit of end of life care MARK SHIPLEY. 1) Standardised approach to end of life care (DNR + LCP). Top ten quality marker.

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Dying from Lung Cancer

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  1. Dying from Lung Cancer An audit of end of life care MARK SHIPLEY

  2. 1) Standardised approach to end of life care (DNR + LCP)

  3. Top ten quality marker DOH End of life care strategy: quality markers and measures for end of life care http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_101684.pdf

  4. 1) 100% of patients who die with lung cancer should have a standardised approach to end of life care, (for example, the Liverpool care pathway) including documentation of resuscitation decisions. DOH End of life care strategy: quality markers and measures for end of life care http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_101684.pdf

  5. 2)Prescription of symptom controlling drugs

  6. Prevalence and Predictors of Symptoms in the Terminal Stage of Lung Cancer * A Community StudyKnut SkaugCHEST February 2007 vol. 131 no. 2 389-394 • Symptoms in last 48hrs lung cancer • Pain 85% • Anxiety 71% • Dyspnoea 54% • Cough 24% • Nausea 21%

  7. In 100% of patients there should be prescription of symptom controlling drugs via appropriate route at appropriate dose. • 2a) Opiate analgesia • 2b) Antiemetic • 2c) Antisecretory • 2d) Benzodiazapine for anxiety Ellershaw John and Ward Chris, (2003) 'Care of the dying patient: the last hours or days of life.' BMJ, 326: pp30-34. The Liverpool Care Pathway. http://www.liv.ac.uk/mcpcil/liverpool-care-pathway/

  8. 3) Communication with patient and relatives

  9. 3) In 100% of patients, if deemed to be in the dying phase then this should be communicated to the patient, and if appropriate, to the relatives (including resuscitation decisions.) Ellershaw John and Ward Chris, (2003) 'Care of the dying patient: the last hours or days of life.' BMJ, 326: pp30-34.

  10. Case Selection • October 2008 – September2009 at FRH • Cases identified by Clinical Coding • 35 Cases with Lung Cancer as cause of death • 1 case excluded as died at QEH • Notes obtained for 33 cases and were reviewed by MDS • Cause of death confirmed on Death Certificates

  11. 1) Standardised approach to end of life care (DNR + LCP)

  12. DNR Decisions • 30 Patients DNR • 22 Consultant decision • 7 SPR decision • 1 SHO decision

  13. Standardised approach to death 9 24

  14. Conclusions • 9/30 Patients with DNR decisions who died of lung cancer had a standardised approach to end of life care • 1 patient for resususcitation as died post stenting • 1 Patient deteriorated following sudden unexplained deterioration • 1Patient no DNR ? Omission

  15. 2)Prescription of symptom controlling drugs

  16. 2a) Opiate analgesia

  17. Opiate Analgesia Choice

  18. Indication Documentation • Opiates given in 18 patients • Indication documented in 6 patients • In all patients where indication was documented – opiates were given

  19. 2b)Benzodiazepines for Anxiety • Prescribed in 24 patients - Given in 21 • Indication in 6 (4 given)

  20. 2c) Antiemetics Anti-emetics given In 6 patients Indication in 4 ( Given in 50%)

  21. 2d) Antisecretion • Hyoscine 400mcg s/c prescribed in 12/33 • Indication documented in 1 • Given in 5 patients

  22. Prevalence and Predictors of Symptoms in the Terminal Stage of Lung Cancer * A Community StudyKnut SkaugCHEST February 2007 vol. 131 no. 2 389-394 • Symptoms in last 48hrs lung cancer • Pain 85% • Anxiety 71% • Dyspnoea 54% • Cough 24% • Nausea 21%

  23. Prevalence and Predictors of Symptoms in the Terminal Stage of Lung Cancer * A Community StudyKnut SkaugCHEST February 2007 vol. 131 no. 2 389-394 • Symptoms in last 48hrs lung cancer • Pain 85% • Appropriate Analgesia 66% • Anxiety 71% • Appropriate Antianxiety 68 • Dyspnoea 54% • indication documentation? • Cough 24% • Appropriate Antisecretory 15% • Nausea 21% • Appropriate Antiemetic 18%

  24. 3) Communication with patient and relatives

  25. Communication • End of life discussed with patient in 13/31 • 1patient admitted unconscious • 1patient deteriorated after falling causing LOC • Discussions with family 26/33

  26. Conclusions • Despite patients with lung cancer being identified as approaching end of life (By DNR) a standardised approach to end of life care is only used in 24% • Anticipatory prescribing is variable, indications are rarely documented and use of drugs is low • Increasing indications may increase drug use • End of life is often not discussed with patients • Discussions are twice as likely to occur with relatives

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