Optimising palliative care for older people in community settings: development and evaluation of a new short term integrated service
This study was a collaboration between King’s College London and Sussex Community NHS Foundation Trust and jointly led by Dr Catherine Evans and Professor Irene Higginson. The study closed in May 2016.
Why is this research important?
People are increasingly reaching advanced ages and live with frailty and progressive difficulties with their health. Palliative care focuses on preventing, detecting and relieving distressing physical, emotional, social and spiritual issues for patients and their families. Palliative care is recommended to support older people to live as well as possible and to die with dignity, but uncertainty surrounds how to achieve this. Main publications:
- Bone AE, Gao W, Gomes B, Sleeman KE, Maddocks M, Wright J, Yi D, Higginson IJ, and Evans CJ, on behalf of OPTCare Elderly ‘Factors Associated with Transition from Community Settings to Hospital as Place of Death for Adults Aged 75 Years or Older: A Population-Based Mortality Follow-back Survey’ Journal of the American Geriatrics Society 2016 DOI: 10.1111/jgs.14442 – Link to paper and Link to Policy Briefing
- Bone AE, Morgan M, Maddocks M, Sleeman KE, Wright J, Taherzadeh S, Ellis-Smith C, Higginson IJ, and Evans CJ ‘Developing a model of short-term integrated palliative and supportive care for frail older people in community settings: perspectives of older people, carers and other key stakeholders’ Age and Ageing 2016 DOI: 10.1093/ageing/afw124– Link to paper and Link to blog
- Evans CJ, Bone AE, Gao W, Morgan M, Taherzadeh S, Maddocks M, Wright J, Lindsay F, McCrone P, Bruni C, Yi D, Hall S, Harding R, Sleeman K, Gomes B and Higginson IJ ‘OPTCare Elderly – Optimising palliative care for frail older people with non-cancer conditions living in the community: a randomised mixed method phase II trial of short-term integrated palliative and supportive care’ BMC Medicine (Target Journal)
- NIHR themed review on EoLC as a case example of innovation in practice to widen access to palliative care - Link to review
Work with older people living in community settings is continuing through our SPACEtoolkit study. Please click here to find out more.
What did the study involve?
What are the key messages?
This study aimed to develop and test a new service for frail older people living at home or in a care home. The new service was short-term integrated palliative and supportive care – SIPSCare, delivered by specialists in palliative care such as a Macmillan Nurses, working closely with primary and community practitioners such as General Practitioners and District Nurses.
The OPTCare Elderly study was a mixed methods study with two phases. Phase 1 (a and b) aimed to develop the SIPSCare service using a post bereavement survey and stakeholder consultations. Phase 2 aimed to test the SIPSCare service with a feasibility trial, exploring the best way to provide the service and potential benefits to both patients and carers. This involved 50 older people and their carer’s, who received either the new palliative care service (SIPSCare) or usual care provided by people like their GP. The new service was delivered by two palliative care teams working with four GPs and community nursing teams and involved up to three visits to review the older person’s care and support. The older person’s symptoms, the services used and costs of care were measured. The methods for this study will inform the set-up of a larger randomised control trial, which will be able to show evidence of the effectiveness of the SIPSCare service.
What are the recommendations for policy and practice?
There is a reliance on hospital care at the end of life for older people, despite the majority preferring to die in their usual place of care.
- Older people who experience severe breathlessness in the last week of life, or have a primary diagnosis of respiratory disease are more likely to transition to hospital as their place of death.
- Older people who have discussed end of life care preferences, or who identify a key health professional who they can rely on, are less likely to transition to hospital.
Link to paper and Link to Policy Briefing
- SIPSCare for frail older people with non-cancer conditions has potential benefits for older people and carers within community settings. Uncertainty surrounds the optimal timing and indicators for this service to maximise benefit.
Link to paper and Link to blog
- SIPS is acceptable to patients/carers and health professions, with potential patient benefit, but we need to consider how to sustain the effect and anticipate individual tailoring.
- It is feasible to identify and recruit the frail elderly through GP practices, use key symptoms and examine treatment effect and deliver the SIPS intervention through integrated working.
Please click here for a summary of the study.
- Invest in evidence-based community breathlessness services for older people to reduce end of life transition to hospital.
- Assign a key healthcare professional, skilled in coordinating care, facilitating complex discussions and in future care planning with older people and their family.
- Increase training for community health care professionals in communication of difficult conversations and anticipatory care planning for older people with uncertain illness trajectories.
- A reconfiguration of community palliative care services to deliver specialist palliative care through integrated working with the existing generalist workforce.
T: +44 (0)20 7848 5516E: Catherine.firstname.lastname@example.org
Alternatively, you can write to:
Catherine EvansDepartment of Palliative Care, Policy and RehabilitationCicely Saunders InstituteKing’s College LondonBessemer RoadLondonSE5 9PJ
The OPTCare Elderly Study is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (Project PB-PG-1111–26071). CE is funded by Health Education England, NIHR Clinical Lectureship in a joint post between King's College London and Sussex Community NHS Foundation Trust. Funding contributed to supporting the authors and investigators on this project comprised Cicely Saunders International, the Gulbenkian Foundation, Atlantic Philanthropies, Medical Research Council, and NIHR Collaboration for Leadership in Applied Health Research & Care South London (a partnership between King's Health Partners, St. George's, University London, and St George's Healthcare NHS Trust).
The funding organizations had no role in the design, methods, analysis, preparation, or approval of the paper. This article presents independent research funded by the NIHR. The views expressed in this publication are those of the authors and not necessarily those of the NHS, NIHR, or the Department of Health.