Dai Roberts

Exploring differences in referrals to a hospice at home service in two socio-economically distinct areas of Manchester, UK

In order to provide equitable access to hospice at home palliative care services, it is important to identify the socio-economic factors associated with poorer access. In this population-based study we aimed to test the inverse care law by exploring how socio-economic status and other key demographic indicators were associated with referral rates in two distinct areas (Salford and Trafford) served by the same service. Secondary data from the UK National Census 2001, North West Cancer Intelligence Service (2004) and hospice at home service referral data (2004—06) was collated for both areas. Descriptive analysis profiled electoral ward characteristics whilst simple correlations and regression modelling estimated associations with referral rates. Referral rates were lower and cancer mortality higher in the most deprived areas (Salford). Referral rates were significantly associated with deprivation, particularly multiple deprivation, but not significantly associated with cancer mortality (service model and resources available were held constant). At the population level, the socio-economic characteristics of those referred to hospice at home rather than service provision strongly predicted referral rates. This has implications for the allocation and targeting of resources and contributes important findings to future work exploring equitable access at organizational and professional levels.

A qualitative study exploring perceptions and experiences of patients and clinicians of Palliative Medicine Outpatient Clinics in different settings

Palliative care exists in a variety of settings and palliative care teams form many guises within this. A Palliative Medicine Outpatient Clinic (PMOC) exists to meet the flexible provision of the needs and preferences of individuals within whatever care setting they reside. This explorative study used a qualitative methodology, capturing patients’ actual experience of care in preference to their satisfaction, as this is a more accurate measure of how and what patients judge as important in their healthcare. The overall themes in this paper point to the ‘value’ that patients perceived from attending the PMOC and how important the clinics were to clinicians that provided the care. The clinic facilitates much more than symptom control and here lies the challenge in how we convert the very positive experience of individuals into a language of outcome measures that captures the ‘essence’ of our work in this fiscally driven health economy.

Complementary therapists’ training and cancer care: A multi-site study

PURPOSE To explore professional experience and training of complementary therapists working within cancer care. METHOD A Questionnaire survey of complementary therapists practising in three cancer care settings in North West England. RESULTS Respondents (n=51; n=47 female; mean age 50 years, range 23-78 years) had varied career backgrounds; 24 were healthcare professionals who also practised as complementary therapists (nurse n=19; physiotherapist n=3; doctor n=2) whilst 27 were complementary therapists with no prior healthcare background. Twenty-eight respondents reported working as therapists within a supportive and palliative care setting for over 6 years. Forty-seven respondents had undertaken healthcare-related continuing professional development in complementary therapies, although only just over half of the sample (n=27) had received cancer-specific training. Cancer-related complementary therapy training related to the adaptation of therapies and comprised predominantly short courses. There was a lack of standardisation in the training received, nor was it clear how many courses were accredited. CONCLUSION Findings highlight the need for standardisation of training for complementary therapy provision in cancer care and statutory review of continuing professional development within this emerging field.

Incidence and causes for syringe driver site reactions in palliative care: A prospective hospice-based study.

Background Syringe drivers are routinely used in palliative care for the subcutaneous infusion of drugs for pain and symptom control. Local site reactions occurring at the site of infusion can lead to patient discomfort and the potential for sub-optimal symptom control. Aim The aim of this study was to investigate whether there was a correlation between drugs administered subcutaneously via a syringe driver and the incidence of syringe driver site reactions, further linking this to time to syringe driver site reaction. Design: Prospective quantitative data collection of syringe driver use for 170 hospice inpatients. Setting/participants: Specialist palliative care inpatient facility in the UK. Syringe driver recording forms were retrieved from case notes of consecutive patients who received medication via a syringe driver. Results: An association between the presence of cyclizine and levomepromazine and the incidence of syringe driver site reactions was identified. A marked difference in incidence of syringe driver site reaction was observed between the two study centres (26.5% vs. 7.7%). Although baseline patient characteristics were comparable, a difference in practice between the centres was identified, i.e. use of parenteral cannulae. An association between the time a syringe driver was in situ and the occurrence of a syringe driver site reaction was also demonstrated. Conclusions: Recommendations can be made for the frequency of syringe driver site changes based on which drugs are in use. Incidental findings from the study have been used to change practice at the hospice study site, with regard to choice of parenteral cannulae.

Evaluating palliative care ward staffing using bed occupancy, patient dependency, staff activity, service quality and cost data

Background: Palliative care staffing has remained unchallenged for decades while service provision has changed markedly, bringing new workforce demands. There is little evidence to inform hospice workforce structures, which strive to deliver the highest-quality holistic care. Aim: The study had three main aims, to: (i) adapt the acuity-quality workforce planning method used extensively in the UK National Health Service (NHS) for use in hospices; (ii) compare hospice and NHS palliative care staffing establishments and their implications; and (iii) create ward staffing benchmarks and formulae for hospice managers. Design: A method adapted from a widely used nursing workforce planning and development (WP&D) study was used to collect data in hospice and palliative care wards. Setting: Twenty-three palliative care and hospice wards, geographically representing England, were studied. Results: A dataset, which profiles and benchmarks hospice and NHS palliative care ward occupancy, patient dependency, staff activity, ward establishments, quality and costs in 23 palliative care and hospice wards has been created. The database reveals large differences between hospice and palliative care wards. For example, hospice wards are better staffed and more expensive to run but staff deliver higher-quality care (measured using an established service quality audit) despite facing heavier workloads. Consequently, staffing multipliers are created to help managers estimate workload-based ward staffing. Conclusions: This dataset provides evidence-based recommendations to inform palliative care nursing workforce modelling, including deciding future nursing workforce size and mix based on rising workloads. The new dataset is suitable for use in UK hospice wards and may be appropriate for future international use.