Understanding Enhanced Supportive Care (ESC)


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Rachel Caulfield1, Jane Gibbins2, Karen Forbes1, Charlotte Chamberlain1
1University of Bristol, 2Royal Cornwall Hospitals NHS Trust

Abstract

Background

Early’ Specialist Palliative Care (SPC) improves outcomes for patients with advanced cancer,  however, patients are often referred late. ‘Enhanced Supportive Care’ (ESC) aims to facilitate earlier integrated supportive care services for those with incurable cancer and adoption of ESC has been recommended across England. This study aims to describe and better understand SPC and ESC services for patients with incurable cancer, since the introduction of ESC.

Method

A cross-sectional survey was sent to lead ESC/SPC nurses and consultants, and oncology consultants (n=262 surveys) in 53 cancer centres across England. The survey was developed using Bristol Online Surveys (BOS). Ethics approval was granted by University of Bristol Research and Enterprise Development.  Free text questions focused on the differences between palliative, supportive and ESC and the strengths and limitations of the ESC service. Multiple-choice questions addressed characteristics of service provision (including triggers for SPC/ESC referral and evidence of integration with oncology). Semi-structured interviews were conducted with surveyed palliative care consultants (n=3). Quantitative results were analysed with basic description in BOS and Fischer’s Exact Test in Excel. Qualitative free text responses and verbatim interview transcripts were analysed with line-by-line coding identifying higher-order themes inductively.

Results

There was a 56% (n=30/53) response rate from SPC and ESC teams.  Oncologists’ response rate was 14.0% (n=14/100).  There is evidence of a lack of clarity when defining ESC and SPC. ESC participants described greater integration of their services with oncology (such as joint case discussions (64% n=9/14 vs 23% n=3/13)) and more timely patient referral compared with non-ESC participants (10/14 vs 4/13 described most referrals being “early” [>6 months before death]). Themes arising from the qualitative interviews echoed the survey findings, describing ambiguity in terms and services with disagreement over the nature of ‘rebranding’ away from SPC, but potentially more timely identification of patients as a result of ESC.

Conclusion

There is current uncertainty around SPC and ESC terminology and heterogenous services for patients with incurable cancer across England. Providers of ESC perceive greater integration with oncology and timely referral for patients.


Impact statement

Study of national SPC and ESC services has the potential to help patients to live well with cancer.