6640 SUNBEAM: embedding paediatric palliative care into the national fetal medicine programme

Objectives In 2021 the All Wales Paediatric palliative care(PPC) service, neonatal colleagues and fetal medicine teams recognised that improved collaborative working was needed. SUNBEAM (Supporting UNcertainty for Babies in the Evolving Antenatal Months) is the result of this. The Welsh SUNBEAM collaborative aims to embed paediatric palliative care into the multidisciplinary fetal medicine MDT. By doing so we hope to support choice and provide an alternative to termination of pregnancy for those families facing the birth of a child where the future is uncertain. From September 2021, the palliative care team integrated into and attended the weekly fetal medicine MDTs. Pregnancies are discussed and referred during these meetings with representation from many subspecialty paediatric teams. This supports understanding of referral pathways, increasing awareness of support options, education of colleagues and enables collaborative discussion in cases where there is often complex medical, emotional and social need. The aim of this review is to evaluate the change in referral patterns since SUNBEAMS inception and to guide future development. Methods The Welsh fetal medicine database was retrospectively reviewed from September 2021 to September 2023. Analysis of this data included the number of families referred to PPC, anticipated diagnosis and other relevant details. Possible 'missed referrals' and other areas for development were also explored. The data collected has been compared to numbers of referrals made to the PPC team before integration into the fetal medicine MDT meetings. Results Referrals to paediatric palliative care have increased. Interim figures for 12 months data analysis show us that there were 28 referrals following the introduction of SUNBEAM compared to 5 in the year prior. These referrals included babies with conditions such as Trisomy 18, Renal agenesis, Anhydramnios and Hydrops. Colleagues from across midwifery, obstetrics, fetal medicine and paediatric subspecialties report improved understanding of the support paediatric palliative care team can offer families. Patient stories also highlight the importance of this. Our analysis noted that there is still room for improvement, with 35 potential missed opportunities for referral, particularly in those babies with cardiac disease. Conclusion Collaborative working and integration of specialist paediatric palliative medicine to the national fetal medicine meeting has increased the number of referrals to palliative care. We recognise an improvement in colleagues' awareness of paediatric palliative care, reduced mis-perceptions and better communication among professionals. We remain aware of pockets of diagnostic category where referrals are infrequent and opportunities to support families may be missed.