Evidence points to many benefits of "early palliative care" to improve patients' quality of life while living with a serious illness. Yet most trials of early palliative care have not included patients with hematologic malignancy (HM). Unfortunately, patients with HM are also known to have heavy symptom burden, significant psychological distress, and aggressive care at the end of life, including a greater likelihood of dying in the acute hospital and receiving chemotherapy at the end of life.
To bridge the service gap, an early integrated palliative care (EIPC) collaboration has been established between Haematology Unit of Queen Mary Hospital and Palliative Medical Unit (PMU) of Grantham Hospital since early 2018. HM patients who failed two or more lines of disease treatment with palliative care needs were identified during hematology clinic visit or joint round. These patients will be referred to our PC services including outpatient clinic, home care, in-patient and day care services after screening.
We have a joint hematology palliative clinic in QMH with palliative medicine, haematology , nursing and clinical psychology input. In the first session, HM patients will be firstly seen by hematologist for disease treatment and then transit to our PC team for symptom management and psychosocial care. Ongoing advance care planning (ACP) will be discussed if patients are ready. Their family caregivers will be provided with counselling and emotional support.
There are also regular hematology joint rounds followed by multidisciplinary case conference (CC) in GH PMU. Our team will provide complicated symptom management including pain while the hematologist will be responsible for disease treatment eg target therapy. We have ethical discussions including chemotherapy, blood transfusion frequency, use of antibiotics as well as antifungal. The CC will focus on the patient acceptance, care plan and discussion on bereavement issues. Clinical psychologist will provide opinion on the management of difficult patients or families.
After one-year review of EIPC, the number of referrals to PC was markedly increased. And some of the major symptoms including appetite, depressed mood, itchiness was improved after follow-up visits in hematology PC clinic. Our pilot result also showed that early PC group (≥3 month) had significantly reduction in the total length of stay (LOS) of acute unscheduled admissions for the last 90 days before death when compared with the late PC group.
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