Contributions
Abstract: P673
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Natural course
Introduction: In the UK 80% of the population wish to die in their usual place of care yet 55% of people with multiple sclerosis (pwMS) will die in hospital.
Aims: to determine factors that impact place of death for pwMS.
Methods: a retrospective notes review from the UK MS Tissue Bank.
Results: Thirty notes were reviewed from 2012-16. 16/30 (53%) died in hospital, 7/30 in nursing homes, 4/30 at home and 3/30 in a hospice. Health interventions increased in the 0-12 months prior to death versus the 13-24 months prior to death in community (p=0.0369) and primary care (p=0.002) but not in secondary care. Increased interventions were not associated with a pwMS dying at home.
Recognition of dying (22/30, p=0.0024) and having an advanced care plan (ACP) (20/30, p=0.0003) were associated with non-hospital death (NHD). Family involvement was associated with recognition of dying (p=0.015) but not with NHD. 14/30 had an MS nurse encounter but did not influence place of death and 13/30 received support from palliative care. Multivariable analysis found recognition a person is dying and having an ACP were independently predictive of NHD (R2=0.52, p=0.034). The mean time prior to death of having an ACP was 9.6±8.1months and dying being recognised was 17.4±27 days (p=0.0004).
A further 85 case-notes were reviewed from 1989-2015, hospital death rates remained stable. An ACP was in place in 28/46 (61%) from 2008 onwards after implementation of the UK end of life care strategy and in 11/37 (29.7%, p=0.015) prior to 2008. The rates of recognition of dying remained unchanged at 42-44% over the whole period.
Conclusion: Hospital deaths remain high for pwMS. In recent cases (2014-16) an ACP and recognition a pwMS is dying were key factors to achieving a NHD however hospital deaths remain unchanged over 30 years despite increased ACPs. This highlights complexity of the challenge of reducing hospital deaths in MS.
Disclosure: Professor R Nicholas Consulting fees Roche and Biogen
"Dr. J Koffman : nothing to disclose"
"Mrs E. Nicholas: nothing to disclose"
Abstract: P673
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Natural course
Introduction: In the UK 80% of the population wish to die in their usual place of care yet 55% of people with multiple sclerosis (pwMS) will die in hospital.
Aims: to determine factors that impact place of death for pwMS.
Methods: a retrospective notes review from the UK MS Tissue Bank.
Results: Thirty notes were reviewed from 2012-16. 16/30 (53%) died in hospital, 7/30 in nursing homes, 4/30 at home and 3/30 in a hospice. Health interventions increased in the 0-12 months prior to death versus the 13-24 months prior to death in community (p=0.0369) and primary care (p=0.002) but not in secondary care. Increased interventions were not associated with a pwMS dying at home.
Recognition of dying (22/30, p=0.0024) and having an advanced care plan (ACP) (20/30, p=0.0003) were associated with non-hospital death (NHD). Family involvement was associated with recognition of dying (p=0.015) but not with NHD. 14/30 had an MS nurse encounter but did not influence place of death and 13/30 received support from palliative care. Multivariable analysis found recognition a person is dying and having an ACP were independently predictive of NHD (R2=0.52, p=0.034). The mean time prior to death of having an ACP was 9.6±8.1months and dying being recognised was 17.4±27 days (p=0.0004).
A further 85 case-notes were reviewed from 1989-2015, hospital death rates remained stable. An ACP was in place in 28/46 (61%) from 2008 onwards after implementation of the UK end of life care strategy and in 11/37 (29.7%, p=0.015) prior to 2008. The rates of recognition of dying remained unchanged at 42-44% over the whole period.
Conclusion: Hospital deaths remain high for pwMS. In recent cases (2014-16) an ACP and recognition a pwMS is dying were key factors to achieving a NHD however hospital deaths remain unchanged over 30 years despite increased ACPs. This highlights complexity of the challenge of reducing hospital deaths in MS.
Disclosure: Professor R Nicholas Consulting fees Roche and Biogen
"Dr. J Koffman : nothing to disclose"
"Mrs E. Nicholas: nothing to disclose"