#2899 IMPLEMENTING THE SERIOUS ILLNESS CARE PROGRAMME (SICP) WITHIN AN OUTPATIENT HAEMODIALYSIS UNITS: A FEASIBILITY STUDY
Authors: Sammut Hannah , Rao Anirudh , Sharma Asheesh , Mcglinchey Tamsin , Mason Stephen 
Published: June 2023

Abstract

Background and Aims
End-stage renal failure affects a frail, elderly, and multimorbid population with high physical and psychological symptoms. The care should integrate core palliative care principles to thoroughly address and support patients' needs. The Serious Illness Care programme (SICP) is a multi-component intervention that promotes meaningful conversations between clinician and patient. The intervention identifies what matters most to the patient, their goals and priorities, and how this aligns with their treatment and care. The SICP was implemented in two dialysis units in the North of England, and we report on the outcomes and learning from this process.

Method
Using a modified cohort design, we applied the principles and tools of the programme within a renal unit in the North of England. We selected two outpatient dialysis units, Unit A (with a population of 43 patients) and Unit B (with 150 patients). An MDT approach was employed to develop a process specific to each unit (Figure 1). Clinician training was complemented with mentoring support and informative education of nursing and administration teams. Outcome data were collected from August 2019 to February 2022. Outcomes recorded (reach metrics and process outcomes) were the number of patients offered a conversation, accepted or declined, the timing of the conversation and follow-up. We applied structured reflection on elements that facilitated participation in the SICP.

Results
Of the conversations that happened, 10 patients preferred to have the conversation on their own, and 7 patients chose to have a family or carer present. In 17 (100%) patients, the conversation naturally led to a ‘statement of wishes’ about their health. In 5 (29%) patients, there was a detailed conversation regarding resuscitation decisions in the event of a cardiopulmonary arrest (DNACPR). Three (17%) patients accepted a ‘Planning your Future Care Guide’, to help them think about more specific advance care planning conversations in the future. Three (17%) accepted a 'Talking to your Family and Friend's’ leaflet to help guide conversations with family. Structured reflection identified two elements that facilitated participation in the SICP were;
Over this period, 18 (53%) of the 34 patients offered the conversation died.

Conclusion
This study demonstrates that the SICP can be successfully implemented within a dialysis unit. It is essential to recognise that some patients want to talk about the future of their illness, whilst some prefer not to. Understanding the person-centred illness and environmental factors that enable patients to engage in these 'future care planning' conversations is important for this intervention's progression. For example, we were surprised that the majority within our small sample wanted to have this conversation independently. We continue to adapt and modify our approach to ensure personalised, holistic care across our dialysis units to enable patients to live as fully as possible with serious illnesses.