Case study:

21 August 2010

Development of a Fatigue, Anxiety and Breathlessness Clinic (FAB) for palliative care patients in the Solihull Marie Curie Hospice catchment area

Key points

A combined clinic to help patients at Solihull Marie Cure Hospice cope with some of the symptoms they may experience is proving popular with patients and carers and is saving staff time while enabling more people to be seen.

The multidisciplinary clinic helps patients with fatigue, anxiety and/ or breathlessness and runs on a four-week rolling programme with patients encouraged to attend one two-hour session each week for four weeks. Spouses and carers are also involved to gain peer support, information and advice and this is backed up by group intervention.

The first week of the programme is focused on discussing and assessing individual needs with each of the successive weeks devoted to a single topic – breathlessness, anxiety and fatigue. There is also a follow-up by phone two weeks later.

Before the combined clinic was set up, OTs and physios held individual clinics for each of the conditions. But after recognising that these symptoms were inter-related it was decided to introduce the combined clinic with a multidisciplinary and holistic approach.

The new approach means that OTs and physios spend less time in the clinics than previously and, because of the introduction of group sessions, more people can be seen. The multidisciplinary approach involves physios, OTs, specialist nurses and doctors with each staff member doing two sessions for two out of four weeks which ensures continuity while meaning they are not committed to the clinic every week. A half-hour meeting is held each week to review referrals and discuss follow-ups and evaluations.

Staff have encouraged AHPs to refer early to ensure patients are seen as soon as possible and before their disease has progressed too far. In addition the four-week clinics are now operating as a continuous programme which has helped reduce the length of time between referral and the clinic start date.

The verbal feedback from patients and carers has generally been very positive. In addition patients and carers are encouraged to complete evaluation forms, a weekly symptom diary and quality of life scores before and after they have attended the clinic. The clinics are also subject to annual reviews.

The clinics can also help to alleviate the fear many have of attending a hospice. In addition, once known to the hospice, many can be directed to other services which may prevent hospital admission – for instance, day hospices, OT intervention for aids and adaptations from a palliative perspective as well as medical or physiotherapy interventions.