S.L.ANG1, C.M. YEE1, A.HUM1
Tan Tock Seng Hospital1
Since August 2018, the Palliative department in Tan Tock Seng Hospital, a tertiary hospital in Singapore, formed a collaborative initiative with the Haematology department of the same hospital to identify hospitalized patients under the haematology department who may require palliative care.
A retrospective audit was conducted in December 2019 of patients who were referred under this initiative from August 2018 to August 2019.
The aim was to determine the symptom burden, reasons for referral, death outcomes, place of death and advance care planning (ACP) completion rate.
Of the 54 patients who were referred, the median age was 73.5 years. Leukaemia was the most common hematological malignancy (42.6%). 27.8% of patients were still on active treatment. The median palliative performance score (PPS) was 45%. The top 3 most common symptoms were tiredness, loss of appetite and pain. The main reasons for referral were for discharge planning (35.2%) and end of life (EOL) discussion (27.8%). 87% of patients had died at the time of analysis (Dec 2019). 63.8% died in hospital. 20.4% had ACP completed.
Regarding ACP completion, though there was substantial discussion with patients and their families about their care preferences, ACP was not formalized into a document as some were discharged before ACP could be completed and signed and others were not prepared to discuss every aspect of ACP. In conclusion, there is a need to understand and identify this group of haematology patients better for which palliative care must be provided.