Introduction
The evaluation of the Initial Assessment Psychosocial Clinic Palliative Care is a model that has been introduced as a quality improvement exercise after the pallaitive care service underwent a process of self assessment against the National Standards Assessment Program (NSAP). The palliative care service was unable to demonstrate a systematic way in which patients and caregivers receive an interdisciplinary assessment focusing on all the domains of 'total' care. The palliative care service is very strong in attending to physical issues and signs of obvious distress, however a process that enables early identification can now be delivered through this new model of care.
Inclusion for the clinic
New referrals to palliative care which are triaged as ‘clinic only’ will be eligible for this service. This triage criteria means that the patient has a high functional score and is well enough to attend a clinic setting for a duration of approximately 90 minutes. The focus of service delivery is based on initial assessment, education and health promotion especially for the primary caregiver.
Methodology
Patient and caregiver satisfaction surveys were developed based on existing tools from the Palliative Care Outcomes Collaborative, and the Palliative Care National Standards Assessment Program. These questionnaires were posted out with a reply paid envelope to patients and their caregivers.
Results
41 patients attended the GP Plus clinic between September 2011 and February 2012. Of those 41 patients that attended 4 attended alone without a caregiver. Of a possible 78 questionnaires sent out to both patient and caregiver we had 36 returned which gave us a 50% return rate.
24 questionnaires were from both patient and caregiver, 4 questionnaires were from carers only, 6 were from patients only, and 2 were from bereaved caregivers.
6 patients died within the study time, and 2 patients died within 3 weeks of attending the clinic.
Outcomes
Overall there were very positive responses to the nature of the clinic. Patients provided a satisfaction rate of 82% - 89% for time with the Nurse Practicioner, 82%-94% for time with the Social Worker and 80%-94% for time with the Psycho-Oncology Nurse. With the exception of the Social Work Clinic caregiver satisfaction scores were generally a little lower with 79%-83% satisfaction with the Nurse Practitioner, 82%-93% satisfaction with the Social Worker and 83%-87% satisfaction with the Caregiver Network Facilitator. Patients appreciated the opportunity for privacy to discuss their own fears and concerns related to the illness in 94% of responses which compared to 83% of caregivers. Qualitative comments support the structure and value of the clinic however further evaluation is proposed to assess the benefit to the referring health care providers.