Service evaluation of community based palliative care and a hospice at home service

Background: Hospices and other palliative and end-of-life care providers are now required to develop services that aim to improve the quality of end-of-life care and choice in terms of place of care and death for those living with or dying from a life-threatening illness. In 2010, an NHS clinical commissioning group in South Yorkshire, UK, produced a strategic plan that aimed to improve the quality and choice of end-of-life care locally. To that end, it established a project team to review the services already provided by the local hospice and to extend the hospice’s already existing services, including expansion of the hospice-at-home service. Aims: To explore the views of key stakeholders, including healthcare staff and service users, with regard to the quality of care provided by the expanded hospice-at-home service and the choice and quality of palliative care available in the community. Four priorities for exploration were identified: the use of electronic records, advance care planning, communication and care co-ordination, and 24-hour access to end-of-life care services. Method: A policy-applied qualitative methodology was used to explore stakeholder views. Four focus groups, using a semi-structured interview schedule, were conducted with four stakeholder groups: patients/carers; community nursing staff; palliative care nurse specialists; and GPs/senior managers. Data analysis used a framework approach to categorise the stakeholder responses according to the four priority areas identified. Findings: A total of 30 participants were recruited from the four stakeholder groups; patients and carers (n=5); community nursing staff (n=6); palliative care nurse specialists (n=9); and GPs and senior managers (n=10). Participants perceived that important aspects of end-of-life care needs were being met. These included quick access to hospice-at-home services particularly over bank holidays, and the prevention of admission to hospital for patients who received visits and treatment at home from this service. These aspects were highly valued by all the participants who took part in the focus groups. Issues that needed improvement were identified and included communication problems between hospital and community services, education and training needs for some staff regarding the use of technology and the limitations of the current service in relation to home visits from the hospice-at-home service. Conclusions: Recommendations for developing end-of-life care services included 24-hour access to home visits over 7 days each week, the provision of training and education for staff in the use of technology, talking to families about advance care planning, and improved communication between and timely transfer of information from hospital to community services when patients are discharged.