<b>P-206</b> Reaching the wider need – a pilot – the orchard supportive care clinic
Bibliographic record
Abstract
Hospice care continues to meet the needs of only a minority of patients who have specialist palliative care needs, either because prognosis is uncertain, patients themselves are not ready to accept ‘hospice’ or referrer/referee do not directly consider palliative care needs or prognosis. Indeed, many patients with non-cancer diagnoses will never see a palliative care specialist despite complex symptomatology and psychological morbidity. Recognising this gap, St Wilfrid’s Hospice developed a pilot clinic to bridge a gap in provision: accepting any patient with complex physical or psychological symptoms needing specialist clinical support/advice -associated with a chronic life-limiting illness of any diagnosis (or its treatment related symptom burden.) Prognosis could exceed 12 months (unlike hospice criteria) or be unestablished/uncertain. The clinic aims were to promote proactive management- including self-management of symptoms, provide information for both patient and carers, offer an advance care planning course and breathlessness/fatigue management course, and provide general emotional support. The multidisciplinary team included a palliative care consultant, 2 CNSs, occupational and physiotherapy, a complementary/art therapy and a volunteer. 65 patients were referred (9 declined input, one died before seen, six were too unwell), 40% of these had non- cancer diagnoses. 60% of referrals came from secondary care (commonest specialities-respiratory, neurology and urology.) Of the 49 patients seen in OSCC, 21 were later transferred to the main hospice caseload as their illness progressed; 12 then died once under the care of the main hospice, all of whom had completed advance care planning before transfer. Patients able to self-report symptoms completed Edmonton Symptom Assessment Scores (ESAS) at initial and follow up consultation. Most striking was the significant degree of psychological distress reported by 85% of the patients and cited as the main reason for referral. This was reflected in higher ESAS scores in the psychological domain and an impact on wellbeing scores.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.027 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".