How is ascites managed in UK hospices?

Dr Clare Statham and Dr Paul Perkins work in the hospital and hospice setting in the UK; here they explain the background to their article published in the September/October issue of the European Journal of Palliative Care.

Dr Clare Statham

Ascites – the accumulation of serous fluid in the abdominal cavity – can result in distressing symptoms for patients,1 including bloating, nausea, breathlessness and disturbances in body image, and these can be helped by paracentesis (fluid drainage).
Paracentesis may be carried out in hospices and, rarely, patients’ homes. We are interested in practice in the hospice setting, so we conducted a study to examine ascites management
in UK hospices.

The current drive for patients to have access to specialist palliative care earlier in their illnesses 2 means that there will be increasing numbers of more complex patients receiving hospice-based care. Many oncology units and general hospitals can safely offer paracentesis – so should hospice resources be used to offer this service? For patients with a very limited life expectancy, paracentesis performed in the hospice, in order to improve comfort, without the discomfort of going for a hospital scan, may be justifiable.

We used the directory of the charity Hospice UK (formerly Help the Hospices) to identify adult hospices in the UK with inpatient facilities. A questionnaire was then sent out to try and compare practice between hospices. A total of 191 hospices were contacted, and 78 replied.

Of 78 respondents, 57 said that a patient with ascites had undergone a paracentesis in their hospice within the last year; 21 said that they had not performed paracentesis in the last year. Fifty-one respondents answered the question that asked if their hospice had a scanner – of these, 30 didn’t have a scanner.

Some of the reasons for not performing paracentesis raised by respondents included concerns around the skill levels of staff: We would have to re-skill ourselves as they are all locally performed under USS (Ultrasound Scan) guidance at the local trust.

There was also concern about the cost of buying and maintaining ultrasound equipment with current financial pressures both in the NHS and in the independent sector.

Our study showed that there is considerable variability in the management of ascites in hospices in the UK, but with little robust evidence to guide practice, this is perhaps not surprising. We hope that the results will encourage hospices to look at their practice, and encourage further debate regarding the management of patients with ascites.

References

  1. Kichian K, Bain V. Jaundice, ascites and hepatic encephalopathy. In: Doyle D, Hanks D, Cherny N, Calman K (eds). Oxford Textbook of Palliative Medicine, 3rd edn. New York: Oxford University Press, 2005.
  2. National Institute for Clinical Excellence. Guidance on Cancer Services: Improving Supportive and Palliative Care for Adults with Cancer. Cancer Service Guideline CSG4. London: NICE, 2004. https://www.nice.org.uk/guidance/csg4 (last accessed 27/08/17).

More about the authors
Clare Statham is a Specialist Registrar in Palliative Medicine, Southampton General Hospital, Southampton, UK.
Paul Perkins is a Consultant in Palliative Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, and Sue Ryder Leckhampton Court Hospice, Cheltenham, UK.

Read the full article in the European Journal of Palliative Care
This post relates to ‘How is ascites managed in UK hospices?’ by Clare Statham and Paul Perkins published in the September/October 2017 edition of the European Journal of Palliative Care (EJPC, (vol. 24 (4) (5). To select the September/October issue, choose ‘Browse the Archive’/2017/September October.

If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.

Read more posts relating to articles published in the European Journal of Palliative Care on the EAPC Blog.

 

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