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Can comprehensive specialised end-of-life care be provided at home? Lessons from a study of an innovative consultant-led community service in the UK

Noble, B.; King, N.; Woolmore, A.; Hughes, P.; Winslow, M.; Melvin, J.; Brooks, J.; Bravington, A.; Ingleton, C.; Bath, P. A.

Authors

B. Noble

N. King

A. Woolmore

P. Hughes

M. Winslow

J. Melvin

J. Brooks

C. Ingleton

P. A. Bath



Abstract

© 2014 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd. The Midhurst Macmillan Specialist Palliative Care Service (MMSPCS) is a UK, medical consultant-led, multidisciplinary team aiming to provide round-the-clock advice and care, including specialist interventions, in the home, community hospitals and care homes. Of 389 referrals in 2010/11, about 85% were for cancer, from a population of about 155000. Using a mixed method approach, the evaluation comprised: a retrospective analysis of secondary-care use in the last year of life; financial evaluation of the MMSPCS using an Activity Based Costing approach; qualitative interviews with patients, carers, health and social care staff and MMSPCS staff and volunteers; a postal survey of General Practices; and a postal survey of bereaved caregivers using the MMSPCS. The mean cost is about 3000GBP (3461EUR) per patient with mean cost of interventions for cancer patients in the last year of life 1900GBP (2192EUR). Post-referral, overall costs to the system are similar for MMSPCS and hospice-led models; however, earlier referral avoided around 20% of total costs in the last year of life. Patients and carers reported positive experiences of support, linked to the flexible way the service worked. Seventy-one per cent of patients died at home. This model may have application elsewhere.

Citation

Noble, B., King, N., Woolmore, A., Hughes, P., Winslow, M., Melvin, J., …Bath, P. A. (2015). Can comprehensive specialised end-of-life care be provided at home? Lessons from a study of an innovative consultant-led community service in the UK. European Journal of Cancer Care, 24(2), 253-266. https://doi.org/10.1111/ecc.12195

Journal Article Type Article
Acceptance Date Feb 23, 2014
Online Publication Date Apr 15, 2014
Publication Date 2015-03
Deposit Date Apr 1, 2022
Publicly Available Date May 30, 2022
Journal European Journal of Cancer Care
Print ISSN 0961-5423
Electronic ISSN 1365-2354
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 24
Issue 2
Pages 253-266
DOI https://doi.org/10.1111/ecc.12195
Keywords Specialist palliative care; End-of-life care; Home care services; Home death; Preferred place of care/death; Mixed methods evaluation.
Public URL https://hull-repository.worktribe.com/output/3564208

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Publisher Licence URL
http://creativecommons.org/licenses/by-nc-nd/3.0/

Copyright Statement
© 2014 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License,which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercialand no modifications or adaptations are made.





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