#3414 Capturing service users’ experience of the integrated community conservative palliative renal care services

Abstract Background and Aims The community-based conservative-palliative kidney care service is currently established in the Black Country, United Kingdom. We have previously presented the entirely community- based service model and the baseline Integrated Palliative Outcome Score (IPOS) survey results for those on supportive care management. This is a follow-up study, assessing the patient-reported experience measure (PREM), comparing baseline and follow-up symptom burden and assessing the symptom burden in new service users. Method Community, nephrology, and palliative care teams devised a service for those individuals identified for conservative kidney care or individuals with renal disease requiring palliative care management. The service consists of weekly telephone clinics, home visits (HV) by the community nephrology specialist nurse and/or jointly with the palliative care team, and a bi-weekly palliative-renal multidisciplinary team (MDT) meeting. Symptoms were assessed using the (IPOS)-renal survey, which asks individuals to rate symptom burden from: not at all, slightly, moderately, severely, to overwhelmingly. Home visits were offered to symptomatic patients. This was performed at baseline to service and repeated 12 months later. A modified Kidney-PREM survey (needling and transport were excluded) was utilized to assess service users’ reflections, as not all themes were appropriate for the Community-Based Conservative-Palliative Kidney Care Service. Results Since January 2022 to date, 101 individuals have been managed using these services. These data reflect the 60 current service users. Forty-one original service users have subsequently passed away. Age: 86.79 ± 7.75 years, 55% female (n = 33), current eGFR: 21.8 ± 11.71 ml/min/1.73m². Patients reported the top-scoring symptoms (severely or overwhelmingly) were poor mobility (20.8%), difficulty sleeping (20.8%), itching (16.7%), followed by poor appetite (12.5%), and weakness/lack of energy (12.5%) in the three days prior to taking the IPOS renal survey. Interestingly, poor mobility and weakness/lack of energy scored highly at baseline and follow-up. As a cohort, itching and poor appetite as priority symptoms varied. This may relate to symptom management. Sixty-five percent of patients felt that the community approach did not waste time waiting for appointments/treatments. The Modified Kidney PREM survey revealed that service users identified the availability of the kidney team as the most favorable aspect of their care. However, 21% of the cohort rated three factors unfavorably: access to their GP, availability of dietary advice, and communication between kidney team members (Fig. 1). The median admission rate pre-introduction to the service was 1 (IQR: 0, 3.5), and after introduction to the service, 0.5 (IQR: 0, 2.50), P = 0.2. Ninety-seven-point-five percent had documented end-stage renal failure counselling. Ninety-three percent had documented escalation of care discussions. Only 6% of the service users did not die in their chosen place of death. Conclusion The cooperative multi-specialty approach has led to favorable patient satisfaction with the service and reduced the time wasted attending healthcare appointments. There remains developmental work on providing service users with dietary advice. However, the service has successfully resulted in the reduction of hospital admissions, face-to-face hospital outpatient appointments, and with the majority of service users, escalation plans are documented and achieved.