Use of Unscheduled Care by Patients with Terminal Cancer.

Problem

Patients with cancer often experience complex pain and symptom control issues that can cause them to presentation to unscheduled care via the GP Out-Of-Hours (GPOOH) service. AimTo understand the patterns, nature and magnitude of these attendances in GPOOH for patients with cancer in their last 12 months of life, with a particular emphasis on pain-related presentations.

Approach

This analysis is a retrospective cohort study of NHS Tayside residents who died from cancer between 01/01/2012-30/06/2015. Patients were identified posthumously using General Register Office ‘Cause of Death’ Data. Routinely collected clinical data from all unscheduled care during their last year of life was collected using Community Health Index (CHI) number searches. Clinical data was linked to demographic and prescribing datasets using patient CHIs. The CHI is a unique patient identification number used in all clinical encounters.

Findings

There were 5738 patients identified as meeting the inclusion criteria; of these, 1828 patients (32%) used the GPOOH service in their last year of life. These 1828 patients accounted for 5922 unique presentations to GPOOH. Most patients (82.5%) presented to GPOOH more than once, with a mode number of presentations of 3, and a range of 1-24 presentations. Forty common presenting complaints were identified; of those, 13.3% were for pain-related presentations and 31% were for administration of palliative care. Detailed analysis is ongoing; preliminary results indicate that, for patients who present to GPOOH approximately 1 in 3 were advised to seek follow-up with their own GP, 1 in 4 had no follow-up, and 1 in 10 received death administration. Only 1% were admitted to hospital.Presentations to GPOOH were significantly more common in the weeks immediately before death, with 61.4% of patients presenting to GPOOH being within 4 weeks of death.

Consequences

One third of patients cancer present to GPOOH in their last year of life; of those who use GPOOH, majority present multiple times. Such presentations become more common in the weeks before death. Presentations are commonly due to uncontrolled pain and palliative care needs. This research can potentially identify factors associated with unscheduled care use and suggest clinical and service provision changes that could be made to improve the patient journey in patients with terminal cancer.