Between a Rock and a Hard Place: The Challenges of Caregiving During a Pandemic for Parkinson's Family Care Partners.

Aim: To understand Parkinson's Disease (PD) care partners' a) specific challenges that led to worsening strain and b) their suggestions for supports to help them during the ongoing pandemic. Method: Using a qualitative descriptive design, semi-structured interviews with family care partners (n = 19) were completed. Participants were recruited from 10 sites across the United States that varied in size, demographics of patient population served, and geographic location (urban, suburban, rural). Interviews were audio-recorded, de-identified, transcribed verbatim, and coded in a phased manner. The research team analyzed the data and identified themes. Results: During the pandemic, the already difficult task of caregiving was made worse by having to choose between poor options. Five themes exemplified PD care partner experiences: (1) Managing risks and benefits of medical care in settings outside the home vs meeting these needs at home; (2) Struggling to maintain employment benefits with the costs of care and risks of bringing in outside caregivers; (3) Struggling to balance caregiving and self-care; (4) Struggling to be supportive and taking on new caregiving roles in the face of less support services; and (5) Wanting social connections and feeling pressured to maintain isolation. Care partners wanted timely access to, and guidance from healthcare teams to help them. Conclusions: Care partner burden was worsened by lack of guidance when confronted by choices that could lead to negative outcomes. Movement disorder and palliative care providers may be able to alleviate some care partner burden through building systems for timely access and guidance.

PALLIATIVE CARE AND COVID-19 PANDEMIC BETWEEN HOSPITAL-CENTRIC BASED APPROACH AND DECENTRALISATION OF HEALTH SERVICES: A VALUABLE OPPORTUNITY TO TURN THE CORNER?

Italy was the first Western EU country to have dealt with the severe effects of the widespread Covid-19 virus since the pandemic began. Many healthcare services were negatively affected, and the delivery of palliative care has been no exception. The Italian healthcare system has suffered more than others due to public spending cuts. The hospital-based approach has not allowed all patients to receive appropriate care. This situation was brought about not only by the pandemic emergency but mainly by pre-existing shortages due to the cut in financial resources before the Covid-19 pandemic. For countries similar to Italy, it is necessary to develop territorialised health care, decongestion hospitals, and strengthen the Third Sector, particularly the voluntary sector. © EuroMediterranean Biomedical Journal 2023.

Tele-ACP amidst COVID-19 pandemic and beyond

BackgroundWhen COVID-19 hit Singapore in 2020, the public was advised to avoid visiting the hospitals unless for essential services. Advance Care Planning (ACP) services in hospital and community had to be stopped to reduce exposure for the public. However, it was not feasible for ACP services to stop with no foresight of when it could resume. Ironically, ACP should all the more be advocated amidst the pandemic.Henceforth, the team planned and implemented a tele-ACP workflow in February 2020 to ensure accessibility in continuity of care and reduce waiting time for ACP appointments.MethodsTele-ACP is conducted only via Zoom, given its security and encryption features. Criteria of patients include ability to read basic English, having electronic device with internet access, and having no severe hearing or speech impairment.Pre-ACP appointment: Zoom details including a guide were sent to patients and/or NHS.On appointment day: Before session starts, ACP Facilitator will ensure that patient and/or NHS are at a space where there is privacy. Internet stability will also be checked.Post-ACP appointment: Signatures will be obtained electronically or via post, while ensuring personal data is well-protected.ResultsFrom February 2020 to November 2022, 105 tele-ACPs (14 General ACPs and 91 Preferred Plan of Care) were completed. 45 were completed in 2020 and 2021 each, while 15 were done in 2022 (as of November). The average duration for tele vs in-person ACPs is both about 90 minutes, indicating that the effort and time spent are not any less despite ACP discussions being done virtually.ConclusionsLooking at the number of tele-ACPs completed and how it is still actively carried out despite COVID-19 situation being stable and restrictions lifted, tele-ACP is clearly in healthy demand. This shows that tele-ACP is here to stay, being both sustainable and transferable to multiple settings.

Review of the advance care planning (ACP) 2.0 programme in TTSH on training, practice and implementation

Aim(s)To evaluate ACP 2.0 programme in TTSH by doing comparative evaluation of 3 aspects namely, training, practice and implementation from FY2017 to FY2022, and the effects of COVID-19 pandemic on the programme.MethodologyRetrospective analysis of ACP data in TTSH and historical developments of the TTSH ACP 2.0 programme was conducted. New developments that were implemented included:Trial of Tele-ACP in FY21–22Implementation of ACP FYI-flag in EPIC systemSelf-registration of access to AIC ACP IT portal by TTSH ACP facilitatorsVirtual ACP training in FY20–22Physical and virtual ACP talks and webinars in partnership with community partnersResultsThe following results were observed:1121 participants attended ACP facilitation training from FY17–21. There was a 39% decrease in training enrolment in FY20 due to COVID-19 pandemic but a 52% increase was recorded in FY21 after training was converted to virtual format.Reduction in number of completed ACP with 12% drop in FY20 and 14% decrease in FY21. Total number of 5312 ACP were completed from FY17–21.240 staff were trained as ACP advocates from FY17–2124 tele-ACP were conducted from April 2021 to March 2022 with monthly average of 2 tele-ACP sessions.ConclusionCOVID-19 pandemic has affected ACP training and facilitation significantly due to nation-wide strict no-visitation policy in hospital, safe distancing measures and general uneasiness of patients and families to visit hospital. In spite of these challenges, the ACP team persevered with continual engagement with different clinical disciplines. The implementation of virtual training, Zoom meetings, webinars and tele-ACP helped to improve the overall outcomes in awareness, educational talks, training and facilitation.

Enhancing palliative care at home: a generalist community nursing case study

What this paper adds: * This case study demonstrated that facilitating ongoing education opportunities that draw on the expertise of local palliative care champions or internal specialists can enhance care provision. * Nurse care managers believe the value of generalist services, particularly home care services, in the generalist-specialist palliative care partnership, needs to be understood and respected. * Tailored investment in home care to provide a general palliative approach would be beneficial given the unique challenges of this mobile workforce. Keywords: Palliative care;home care services;Education, Nursing;qualitative research;Nurse Practitioner BACKGROUND Palliative care focuses on improving the quality of life of people affected by life-threatening illnesses, including the prevention and relief of suffering through identification, assessment and treatment.1 This care extends to family members, and encompasses physical, psychological, social and spiritual support. Home nursing and care organisations are key providers of community-based palliative care, with staff often the linchpin, in supporting palliative clients, organising and providing care, coordinating the input of other professionals and of specialist equipment.5 Previous research has identified the difficulties faced by home care nurses in meeting their clients' palliative care needs, such as symptom management and communication, as well as requirements for further training to enhance their knowledge and confidence of caring for palliative clients.5-7 In this context, generalist palliative care is delivered by health and care professionals with broad clinical responsibilities who provide primary, ongoing care;and have established relationships with the person and their care community.2 This is distinct from specialist palliative care services which support complex needs through multidisciplinary teams with specialised palliative care training. FINDINGS AND DISCUSSION Thematic analysis identified the following overarching themes: 1) targeted education increased staff knowledge and confidence, but more is needed;2) collaborative teamwork with effective communication and information sharing underpins a successful generalist-specialist partnership;3) the home care setting is unique and requires accessible systems and processes.

Effectiveness of a complex advance care planning intervention focusing on nursing home residents: first results of the cluster-randomized controlled BEVOR-trial

BackgroundFew trials on advance care planning (ACP) have investigated the clinical effect on care consistency with care preferences (3CP) in the nursing home (NH) setting.MethodsBEVOR is a multi-centre, cluster-randomized controlled trial aimed to improve 3CP in NH residents (09/2019–02/2023). A total of 44 NHs from 4 German regions were randomized either to the control group (n=24) or the intervention group (n=24). The complex ACP intervention comprised the offer to lead ACP conversations with qualified facilitators on the individual (resident) level and offers for organizational development and staff education on the institutional (NH) level. Educational ACP modules were offered to emergency medical services, hospitals and other regional players relevant for these residents' medical care.After a run-in phase of the intervention, which was extended due to the Covid19-pandemic from originally 9 to (up to) 18 months, the observation period was 12 months from September 2021 to August 2022. Primary outcome was defined as hospitalization rate, understood as a surrogate parameter for 3CP, collected as anonymous data from all residents of the participating NHs. Main secondary outcome is 3CP, taken from a subset of 892 residents (20.5%) who gave informed consent. To measure 3CP, treatment decisions in potentially life-threatening events (‘care delivered') were identified retrospectively every 3 months from the NH records. Correspondingly, ‘care preferences' were assessed retrospectively, integrating data from residents' files and interviews with residents, proxies and nurses, also taking into account the effected level of shared decision making. Analysis of the primary outcome follows the intention-to-treat principle.ResultsThe main outcomes will be available by the time of the acp-i conference.ConclusionResults of the BEVOR trial will give insights into possible clinical effects of a complex regional ACP intervention.

Palliative care, end-of-life care, and COVID-19: A scoping review / Cuidados paliativos, cuidados de fin de vida y COVID-19: revisión de alcance / Cuidados paliativos, cuidados em fim de vida e COVID-19: uma revisão do escopo

Introducción: La COVID-19 exacerbó el déficit en la prestación de cuidados paliativos y de fin de vida y aumentó la sobrecarga de los servicios de salud, pero se desconoce la extensión de la literatura sobre dicho tema. Objetivo: Describir la evidencia sobre la prestación de cuidados paliativos y de fin de vida en adultos durante la pandemia de COVID-19. Materiales y métodos: Revisión de alcance según el marco metodológico de Arksey y O'Malley. La búsqueda se realizó en inglés y español; en PubMed, Scielo, la Biblioteca Virtual en Salud, y la base de datos de investigación en Coronavirus. Las publicaciones se filtraron por título, resumen y lectura completa. Los resultados se sintetizaron de acuerdo con la técnica "charting". Resultados: Se incluyeron 51 publicaciones. En total emergieron cinco categorías: 1) caracterización de los cuidados paliativos, 2) planificación avanzada de cuidados, 3) acompañamiento a familiares y seres queridos, 4) telesalud, 5) rol de enfermería en los cuidados paliativos. Discusión:: El coste social de la pandemia se refleja en el aumento en la carga de unidades de cuidados paliativos, mayor porcentaje de mortalidad y la disminución de la edad promedio de fallecimiento. Futuros estudios deben abordar el impacto psicosocial en los seres queridos de los pacientes, así como el impacto a nivel comunitario. Conclusión: Los cuidados paliativos y de fin de vida constituyen una herramienta fundamental para la atención de pacientes con COVID-19. La pandemia potenció el desarrollo de las tecnologías de la información y las comunicaciones para la prestación de cuidados paliativos.

Introduction:COVID-19 exacerbated the deficit of palliative and end-of-life care provision and increased healthcare services' burden, but the extent of the literature on that topic is unknown. Objetive: To describe the evidence of palliative and end-of-life care provision in adults during the COVID-19 pandemic. Materials and Methods:The scoping review was performed according to Arksey and O'Malley's methodological framework. The search was conducted in English and Spanish, in PubMed, SciELO, the Virtual Health Library, and the Coronavirus research database. The articles were filtered by title, abstract, and full text. The results were summarized according to the charting technique. Results: Fifty-one publications were included. A total of five categories emerged: 1) Palliative care characteristics, 2) advanced care planning, 3) support for family members and loved ones, 4) telehealth, and 5) nursing role in palliative care. Discussion:The social cost of the pandemic is reflected in the increased burden of palliative care units, higher mortality rates, and the decreased average age of death. Future studies should address the psychosocial impact of COVID-19 on patients' loved ones, as well as the impact at the community level. Conclusions: Palliative and end-of-life care is an essential tool for COVID-19 patients care. The pandemic has enhanced the development of information and communication technologies to deliver palliative care.

Introdução: A COVID-19 exacerbou o déficit na prestação de cuidados paliativos e em fim de vida e aumentou a sobrecarga sobre os serviços de saúde, mas a extensão da literatura sobre tal tópico é desconhecida. Objetivo: Descrever as evidências sobre a prestação de cuidados paliativos e de fim de vida em adultos durante a pandemia da COVID-19. Materiais e Métodos: Revisão do escopo de acordo com a estrutura metodológica de Arksey e O'Malley. A pesquisa foi realizada em inglês e espanhol; PubMed, Scielo, a Biblioteca Virtual de Saúde e o banco de dados de pesquisa do Coronavirus. As publicações foram filtradas por título, resumo e texto completo. Os resultados foram sintetizados de acordo com a técnica gráfica. Resultados: 51 publicações foram incluídas. No total, surgiram cinco categorias: 1) caracterização dos cuidados paliativos, 2) planejamento de cuidados avançados, 3) acompanhamento de parentes e entes queridos, 4) telesaúde, 5) papel de enfermagem nos cuidados paliativos. Discussão: O custo social da pandemia se reflete no aumento da carga sobre as unidades de cuidados paliativos, maiores taxas de mortalidade e uma diminuição da idade média de morte. Estudos futuros devem abordar o impacto psicossocial sobre os entes queridos dos pacientes, bem como o impacto a nível comunitário. Conclusões: Os cuidados paliativos e de fim de vida são uma ferramenta fundamental para o cuidado de pacientes com COVID-19. A pandemia tem melhorado o desenvolvimento das tecnologias de informação e comunicação para o fornecimento de cuidados paliativos.

The underrepresentation of palliative care in global guidelines for responding to infectious disease outbreaks: a systematic narrative review.

BACKGROUND: The importance of palliative care provision has been highlighted in previous humanitarian emergencies. This review aimed to examine the breadth and depth of palliative care inclusion within global guidelines for responding to infectious disease outbreaks. METHODS: The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Electronic searches of MEDLINE, Embase, Cumulative Index to Nursing and Allied Health, PsychInfo and grey literature were performed. Inclusion criteria were guidelines (recommendations for clinical practice or public health policy) for responding to infectious disease outbreaks in the general adult population. Results were limited to the English language, between 1 January 2010 and 17 August 2020. Analysis of the included articles involved assessing the breadth (number of palliative care domains covered) and depth (detail with which the domains were addressed) of palliative care inclusion. RESULTS: A total of 584 articles were retrieved and 43 met the inclusion criteria. Two additional articles were identified through handsearching. There was limited inclusion of palliative care in the guidelines examined. CONCLUSIONS: There is an opportunity for the development of guidelines that include information on palliative care implementation in the context of infectious disease outbreaks in order to reduce the suffering of key vulnerable populations worldwide.

End-of-Life Care and Advanced Directives in Hispanic/Latinx Patients: Challenges and Solutions for the Practicing Oncologist.

Advanced end-of-life care (EOL) comprises a group of strategies to provide comfort to patients at the end of life. These are associated with better quality of life, better satisfaction, and a lower rate of hospitalizations and aggressive medical treatment. Advanced EOL care, including advanced directives completion and hospice enrollment, is suboptimal among Hispanic/Latinx patients with cancer due to personal, socio-cultural, financial, and health system-related barriers, as well as due to a lack of studies specifically designed for this population. In addition, the extrapolation of programs that increase participation in EOL for non-white Hispanics may not work appropriately for Hispanic/Latinx patients and lead to overall lower satisfaction and enrollment in EOL care. This review will provide the practicing oncologist with the tools to address EOL in the Hispanic/Latinx population. Some promising strategies to address the EOL care disparities in Latinx/Hispanic patients have been culturally tailored patient navigation programs, geriatric assessment-guided multidisciplinary interventions, counseling sessions, and educational interventions. Through these strategies, we encourage oncologists to take advantage of every clinical setting to discuss EOL care. Treating physicians can engage family members in caring for their loved ones while practicing cultural humility and respecting cultural preferences, incorporating policies to foster treatment for the underserved migrant population, and providing patients with validated Spanish language tools.

Occurrence of Advance Care Planning and Hospital Course in Patients Admitted for Coronavirus Disease 2019 (COVID-19) During the Pandemic.

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic highlighted the importance of understanding patients' goals, values, and medical care preferences given the high morbidity and mortality. We aimed to examine rates of advance care planning (ACP) documentation along with hospital course differences in the absence or presence of ACP among hospitalized patients with COVID-19. METHODS: This retrospective cohort study was performed at a single tertiary academic medical center. All adults admitted between March 1, 2020, and June 30, 2020, for COVID-19 were included. Demographics, ACP documentation rates, presence of ACP forms, palliative care consultation (PCC) rates, code status, and hospital outcome data were collected. Data were analyzed with multivariable analysis to identify predictors of ACP documentation. RESULTS: Among 356 patients (mean age 60.0, 153 (43%) female), 97 (27.2%) had documented ACP and 20 (5.6%) had completed ACP forms. In patients with documented ACP, 52.4% (n = 55) de-escalated care to do-not-resuscitate (DNR)-limited or comfort measures. PCC occurred rarely (<8%), but 78% (n = 21) of those consulted de-escalated care. Being admitted to the intensive care unit (ICU) (OR = 11.1, 95% CI = 5.9-21.1), mechanical intubation (OR = 15.8, 95% CI = 7.4-32.1), and discharge location other than home (OR = 11.3, 95% CI = 5.7-22.7) were associated with ACP documentation. CONCLUSIONS: This study found low ACP documentation and PCC rates in patients admitted for COVID-19. PCC and completion of ACP were associated with higher rates of care de-escalation. These results support the need for pro-active ACP and PCC for patients admitted for serious illnesses, like COVID-19, to improve goal-informed care.

Understanding advance care planning in care homes throughout the COVID-19 pandemic: A critical realist review and synthesis.

BACKGROUND: The COVID-19 pandemic has disrupted advance care planning discussions in care homes, particularly discussions involving relatives and surrogate decision makers. There is a need to collate and examine current evidence to assess the extent of the problem. AIM: To examine the processes and experiences involved in advance care planning in care homes throughout the COVID-19 pandemic. DESIGN: A critical realist review and synthesis. DATA SOURCES: MEDLINE, psycINFO, SCOPUS and CINAHL were searched between December 2019 and May 2022. RESULTS: Eleven studies were included. Communication difficulties associated with remote technologies meant that care home staff's concerns about engaging effectively with relatives further exacerbated the emotional toll of dealing with high death rates in circumstances where staff shortages stretched the capacity of those remaining to provide timely advance care planning discussions. The threat of the pandemic tended to encourage earlier and more frequent advance care planning discussions, though this tendency was partially countervailed by the difficulties that some residents and relatives had in engaging with remote communication modes. There was evidence that education and training in advance care planning increased staff's confidence and readiness to engage in care planning during pandemic conditions. CONCLUSION: Results highlight part of the new context facing staff, relatives and residents in care homes, thus providing valuable insight for future intervention development required to maintain and improve the effectiveness of advance care planning in care homes during and beyond the pandemic.

Joining Forces: The Addition of a Palliative Care Practitioner to a Resident Teaching Service During COVID-19 Pandemic as a Tool to Improve Patient Care and Provider Communication.

The COVID-19 pandemic has presented an array of novel issues for hospitals and their staff, 1 of the most noted being increased patient isolation due to visitation restrictions. This has created new challenges for health care systems and their workers. To leverage the expertise of Palliative Care Practitioners (PCP) as described here to improve patient/provider communication, patient experience, and quality of care during the COVID-19 pandemic. To address these new obstacles to patient care presented by the pandemic, a PCP was incorporated into the physician team caring for COVID-19 patients at the time of admission. Members of the care team were surveyed and interviewed regarding their experiences with this added support. During a period of peak hospital strain from COVID-19, team members consistently reported that daily PCP involvement led to improvement in communication with patients and families, greater provider awareness of psychosocial stressors, and decreased physician burnout. Integration of a PCP into a clinical care team during the COVID-19 pandemic was perceived as a valuable asset to patients, families, and clinicians.

Y-site injection physical compatibility of remdesivir with select intravenous drugs used in palliative care and for treating coronavirus disease 2019.

BACKGROUND: No compatibility tests are available for remdesivir other than 0.9% sodium chloride. In this study, we aimed to evaluate the physical compatibility of remdesivir with drugs used in palliative care and COVID-19 treatment. METHODS: Remdesivir was tested for compatibility with 10 different drugs (fentanyl, morphine, hydromorphone, oxycodone, heparin, furosemide, octreotide, acetated Ringer's injection, 2-in-1 peripheral parenteral nutrition, and 2-in-1 total parenteral nutrition). Remdesivir was formulated to a final concentration of 1 mg/mL, and the other drugs were prepared at clinical concentrations. Three test solutions were used for compatibility testing, with remdesivir and the target drugs compounded in a 1:1 ratio. Appearance measurements, including Tyndall effect, turbidity, and pH, were performed immediately after mixing and at 1 h and 4 h after mixing. Changes in appearance, including the Tyndall effect, turbidity (turbidity change of ≥ 0.5 nephelometric turbidity unit [NTU] based on control solution for each test drug), and pH (a change of ≥ 10% based on the pH immediately after mixing) were used to determine physical compatibility. RESULTS: All the drugs tested were compatible with remdesivir. The combination of remdesivir and furosemide produced the highest turbidity (0.23 ± 0.03 NTU) 1 h after mixing. The lowest and highest pH values were observed at 4 h after mixing for the combinations of remdesivir and morphine (3.23 ± 0.02) and remdesivir and furosemide (8.81 ± 0.06). CONCLUSIONS: The drugs tested in this study show Y-site physical compatibility with remdesivir.

Clinical usefulness of the Patient-Generated Subjective Global Assessment and modified Glasgow Prognostic Score in decision making concerning the indication of enteral nutritional therapy in patients with incurable cancer receiving palliative care.

OBJECTIVES: This study aimed to identify the clinical usefulness of assessing nutritional status using validated tools for the indication of enteral nutrition for patients with incurable cancer in palliative care. METHODS: In this prospective cohort study, patients were assessed for nutritional risk using the Patient-Generated Subjective Global Assessment and for cancer cachexia (CC) using the modified Glasgow Prognostic Score upon enrollment and after ∼30 d. The outcome was stable or improved Karnofsky Performance Status. Logistic regression models were used, providing the odds ratio (OR) and 95% confidence interval (CI). RESULTS: A total of 180 patients participated. The only nutritional status parameter that was associated with function was CC. The less severe the CC, the more likely Karnofsky Performance Status was to remain stable or improve over 30 d (non-cachectic: OR = 1.95; 95% CI, 1.01-3.47; malnourished: OR = 1.06; 95% CI, 1.01-1.42). Furthermore, white skin color (OR = 1.79; 95% CI, 1.04-2.47), higher educational level (OR = 1.39; 95% CI, 1.13-2.78), and inadequate calorie intake (OR = 1.96; 95% CI, 1.02-2.81) were also associated with the outcome. CONCLUSIONS: Using the modified Glasgow Prognostic Score to identify the existence and severity of CC, which is associated with function, has the potential to help clinical decision making concerning the indication of enteral nutrition in patients with incurable cancer receiving palliative care.

[Foot reflexology for caregivers in palliative care]. / La réflexologie plantaire au service des soignants de soins palliatifs.

Foot reflexology is the use of massage and acupressure techniques on the feet, which represent each organ of the human body. The reflexologist knows precisely the anatomy of the body and the reflex points on the feet in order to relieve and treat the person's problems. A team from the University Hospital of Clermont-Ferrand shares a very positive experience, unfortunately interrupted by the Covid-19 health crisis.

Risk factors for delirium among patients with advanced cancer in palliative care: a multicenter, patient-based registry cohort in South Korea

OBJECTIVE: Previous studies have comprehensively investigated the preva-lence and various potential risk factors for de-lirium among patients with advanced cancer ad-mitted to the acute palliative care unit (APCU). Our objective was to evaluate the comprehen-sive association between delirium and various risk factors among patients with advanced can-cer in an acute palliative care setting using a pa-tient-based multicenter registry cohort.PATIENTS AND METHODS: We performed a multicenter, patient-based registry cohort study collected in South Korea between January 1, 2019, and December 31, 2020. Delirium was identified using a medical record review based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.RESULTS: In total, 2,124 eligible patients with advanced cancer in the APCU met the inclu-sion criteria. There were 127 out of 2,124 pa-tients (prevalence, 6.0%;95% CI, 5.0 to 7.1) with delirium during admission. Delirium in patients with advanced cancer was associated with age >70 years (OR, 1.793;95% CI, 1.246 to 2.581), male sex (OR, 1.675;95% CI, 1.131 to 2.479), no chemotherapy during hospitalization (OR, 2.019;95% CI, 1.236 to 3.298), hearing impairment (OR, 3.566;95% CI, 1.176 to 10.810), underweight (OR, 1.826;95% CI, 1.067 to 3.124), current use of opioid medication (OR, 1.942;95% CI, 1.264 to 2.982), previous history of delirium (OR, 12.497;95% CI, 6.920 to 22.568), and mental illness (OR, 2.333;95% CI, 1.251 to 4.352).CONCLUSIONS: In a large-scale multicenter patient-based registry cohort, delirium was asso-ciated with old age, male sex, no chemotherapy during hospitalization, hearing impairment, un-derweight, current use of opioid medication, and a history of delirium and mental illness. Our find-ings suggest physicians should pay attention to delirium in patients with advanced cancer admit-ted to the APCU with the above risk factors.

Quality Improvement Evaluation of a Veterans' Palliative Care Telehealth Music Therapy Program

Music therapy is an important psychosocial aspect of hospice and palliative care programs to address pain, grief, and anxiety. The COVID-19 pandemic introduced new challenges to psychosocial therapies in palliative care, including the inability of families to be at the bedside of seriously ill patients, and the need to provide services remotely through video technology. Due to this sudden shift in service delivery, music therapists adapted without research evidence or evaluation of service quality. This evidence-based quality improvement (QI) evaluation examined the program effectiveness of music therapy telehealth services at one Veterans Affairs Medical Center (VAMC) for patients in palliative care, their family members, and VAMC staff during this time of societal grief, anxiety, and isolation. Evaluation metrics included patient (n = 39), staff (n = 27), and family member (n = 3) responses to QI surveys, and analysis of journal entries from key stakeholders (i.e., music therapist, nurse case manager, palliative care physician). We conducted a content analysis of QI surveys and completed the first and second cycle coding of journal entries. Results from the QI survey indicated that music therapy telehealth provided affective and interpersonal benefits, and increased compliance with other therapies. Reflections from key stakeholders included clinical recommendations for service implementation and descriptions of the influence of the telehealth modality on the therapeutic relationship. Findings suggested that music therapy telehealth services can provide psychosocial support for veterans, families, and staff in palliative care. QI research may be utilized to provide helpful ongoing feedback regarding clinical effectiveness.

PP07.003 Why do some people record place of death preferences and some not? Analysis from an electronic palliative care coordination system

BackgroundConsideration and documentation of where individual patients want to die is an important component of advance care planning and helps facilitate care aligned with patients' wishes.AimTo examine factors associated with recording a preferred place of death in Coordinate My Care, a large Electronic Palliative Care Coordination System in London.MethodsAdults with a Coordinate My Care Record, between 01/01/2018 and 05/03/2021 were included. Logistic regression modelling was used to identify clinical, social and demographic factors associated with documenting preference for place of death. Timing of record creation (pre and during the Covid-19 pandemic) was also included.Results72,591 records were analysed (52,006 (71.6%) with a recorded preferred place of death and 20,585 (28.4%) without). Individuals with a recorded preferred place of death were more likely to be older (Aged 80+ compared to <80) OR: 1.19, CI 1.14 – 1.24), less functionally independent (WHO performance status 4 compared to 1, OR: 1.28, CI 1.19 – 1.37), have a ‘Do Not Attempt Cardio-Pulmonary Resuscitation' status (OR: 1.70, CI 1.60 – 1.80), be from least deprived areas (compared to most deprived, OR: 1.08, CI 1.01 – 1.16), live in a care home (OR:1.42, CI 1.35 – 1.50), create their record in the General Practice setting (compared to at an hospital setting OR: 1.42, CI 1.34 – 1.53) and have created their record during the initial wave of the pandemic (compared to pre-pandemic OR: 1.56, CI 1.49 – 1.63).ConclusionsHealth status, living and socio-economic circumstances and the Covid-19 pandemic were associated with whether or not patients had a documented preference for place of death. This has implications for professional training and patient empowerment in terms of having conversations about what matters most to patients at the end of life and how to provide patient centred end-of-life care.

PP07.002 The impact of advance care planning on place of death during the COVID-19 pandemic

BackgroundAt the beginning on the COVID-19 pandemic, advance care planning (ACP) was widely encouraged and endorsed for adults with serious illness to ensure their treatment and care preferences would be honoured, including location of death, often considered a surrogate quality indicator for end-of-life care. Coordinate My Care (CMC) represents the UK's largest Electronic Palliative Care Coordination System that comprises an ACP component.We aimed to examine the impact of ACP on place of death for people who died during the COVID-19 pandemic with a CMC record.MethodsRetrospective cohort analysis of CMC records for people aged over 18 who died between 20/03/20 and 05/03/21 with recorded place of death. Socio-demographic, clinical and ACP-related factors associated with achieving preferred place of death (PPD) were examined using logistic regression.Results11,913 records were included. 76.9% patients died in their preferred place location of death (57.7% Home, 31.4% Care Home, 7.5% Hospice, 3.3% Hospital, 0.1% Other). An increased likelihood of dying in PPD was associated with a ‘Not for resuscitation' (DNACPR) status (OR=1.51, 95% CI 1.17 to 1.93), a Ceiling of Treatment for Symptomatic Treatment (when compared to Full active treatment, OR=3.52, 95% CI 2.77 to 4.50), documented family discussions regarding resuscitation recommendations (OR=1.51, 95% CI 1.33 to 1.72) and 2+ non-urgent care record views in the 30 days before death (OR=1.27, 95% CI 1.13 to 1.43). People from materially deprived areas had a decreased likelihood of dying in their PPD (OR= 0.65, 95% CI 0.54 to 0.79).ConclusionsModifiable elements of ACP significantly influence place of death, even when controlling for socio-economic and demographic determinants. In times of crisis, effective ACP is central to delivering high quality end-of-life care;ACP related factors must be considered in ongoing research on end-of-life outcomes.

PP10.003 The causes of discordant between advanced care plan preference and end-of-life care treatment in patients received conservative kidney management

BackgroundShare decision-making and advance care planning (ACP) is essential for patients with end-stage renal disease (ESRD). Karunrak Palliative Care Center started a Renal Palliative Care Program in 2017, which is the first joint Chronic kidney disease-Palliative care program in Thailand. ESRD patients always received discordant end-of-life care (EOLC).MethodsThe causes of the discordance of EOLC of conservative kidney management (CKM) patients who died during the period of October 1, 2020 to September 30, 2022 were retrospectively reviewed.ResultsThe demographic data of 38 deceased CKM patients were: 78.9% aged ≥75;55.3% Charlson comorbidity index ≥8, 89.5%;Karnofsky Performance status > 40%. Median survival time after entered the program was 409.0 days, IQR= 184.5–602.5 days and 42.1% is greater than 12 months. All patients had ACP documentation, but only 15.8% had advance directive.ConclusionThe causes of discordance between ACP preferences and actual EOLC received majority are from severe symptoms especially dyspnea. Other serious illnesses which led to hospitalization in this report are COVID-19 infection and stroke.