Does a social model of hospice day care affect advanced cancer patients’ use of other health and social services? A prospective quasi-experimental trial

Abstract

Hospice day care (HDC) services have developed but no trials evaluate their impact on the other health and social care services. The purpose of this study was to evaluate the effect of HDC on the use of health and social services in a prospective quasi-experimental study. The trial compared consecutive patients receiving HDC, with two control groups: a 'before' group and a 'standard care' group. All data was collected in face to face interviews at baseline and then at 6-8 weeks and 12-15 weeks. The health and social service use at baseline and follow-up interviews were examined by five categories (community, hospice, social care support, hospital, and therapist). The multivariate analysis of covariance (MANCOVA) was used to test service use differences between groups, adjusting for potential confounders. In total, 37, 50, and 76 patients were recruited to the day care, standard care and before groups. Patients in the HDC group used significantly more social care support (11.5 +/- 18.9 versus 3.2 +/- 10.0, P = 0.015) and therapists (0.9 +/- 1.7 versus 0.2 +/- 0.4, P = 0.009) than the standard care at the baseline. The therapist service use from the baseline to the first follow-up reduced (mean change +/- SD, -0.3 +/- 0.6; 95%CI, -0.7 to 0.0) in the HDC group and increased in the standard care group (mean change +/- SD, 0.1 +/- 0.5; 95%CI, -0.1 to 0.3), the difference was significant (P = 0.003). No other changes in service use were significant in other study periods. HDC appears to supplement existing services with little effect on the other community and hospital services.