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ImproveCare - The management of clinical uncertainty in hospital settings

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OUT NOW! See our recently published results paper, the NIHR Final Report, and the presentations from the 16th World Congress of the European Association for Palliative Care below!                

Why is this research important?

500,000 people die per year in the UK; half of all deaths occur in   hospital. Most people prefer to die at home but this does not happen because   there is little discussion between patients, families, and health care professionals about what they want. It is made worse when it is difficult for health care staff to identify patients, whose situation is clinically uncertain. This is an area of care many professionals feel less confident in their knowledge/skills.

The AMBER care bundle has been identified by NHS England as one of   five key enablers to Transform End of Life Care in Acute Hospitals and it is   currently being used in approximately 40 hospitals In England, including   district general hospitals. It is essential that a clinical trial of the  AMBER care bundle takes place to quantify patient, clinician and health system benefits, and that any harms are understood and managed prior to   rollout of the care bundle to more hospitals.   

Now, more than ever (with ageing populations and increasing numbers   of people dying from cancer and non-malignant conditions), health care   systems should provide every patient and their family with a dignified death.   Facing deteriorating health and uncertain recovery is distressing for patients who may be dying, and their families, and costly for health services and society.

 What does this study involve?

In this study, AMBER care will be compared with usual care. This study aims to help us know if can recruit enough people, that the outcomes we use reflect what patients and families feel are important, whether it represents good value for money, and that the study procedures are workable. The   study was based at four study sites in England and will be coordinated by the   research team based at the Cicely Saunders Institute, King’s College London. All the study sites are district general hospitals and the study wards are general medical ward. Recruitment finished in October 2018. The two sites   have been allocated at random for patients to be cared for using the AMBER care bundle, the other two sites will carry on providing usual care for this group of patients. Patients were asked to complete a questionnaire at the three time points: baseline, 3 to 5 days after and 10-15 days after the completion of the first questionnaire. For a group of patients and their   relatives short interviews were held regarding the patient’s illness and   care. Additionally, we conducted focus groups with the healthcare professionals, observed their multidisciplinary team meetings and ask them to fill in a questionnaire about the care provided at the ward at the study sites. We also sent out a post-bereavement survey to the relatives of patients who have lost their lives during or shortly after the study.

Trial registration: ISRCTN36040085 DOI 10.1186/ISRCTN36040085

Link to the trial registration website can be found here.

Link to the results paper:

Koffman J, Yorganci E, Yi D, Gao W, Murtagh F, Pickles A, Barclay S, Johnson H, Wilson R, Sampson L, Droney J. Managing uncertain recovery for patients nearing the end of life in hospital: a mixed-methods feasibility cluster randomised controlled trial of the AMBER care bundle. Trials. 2019 Dec 1;20(1):506.

Link to the NIHR Final Report:

Koffman J, Yorganci E, Murtagh F, Yi D, Gao W, Barclay S, et al. The AMBER care bundle for hospital inpatients with uncertain recovery nearing the end of life: the ImproveCare feasibility cluster RCT. Health Technol Assess 2019;23(55)


Who is involved?

Dr Jonathan Koffman – Chief Investigator

Dr Catherine Evans – Co-investigator

Dr Deokhee Yi – Co-investigator/ Health Economist

Dr Fliss Murtagh – Co-investigator

Dr Wei Gao – Co-investigator/ Trial Statistician

Dr Stephen Barclay – Co-investigator (based at the University of Cambridge)

Professor Andrew Pickles – Co-investigator

Emel Yorganci – Research Assistant

This study is a collaboration between King’s College London and University of Cambridge led by Dr Jonathan Koffman. ImproveCare is a feasibility cluster randomised controlled trial comparing the AMBER care bundle (ACB) to usual care.  


Contact us:

To find out more about the ImproveCare study and further information on our research please do not hesitate to contact the research assistant via any of the methods below.

Name: Emel Yorganci

Tel: 020 7848 5418


King's College London
Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation
Bessemer Road, London, SE5 9PJ, UK



ImproveCare is funded by the National Institute for Health Research Health and Technology Assessment (NIHR HTA) programme. Project number: 15/10/17


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