Palliative care in rural areas.

Abstract

We were surprised and disappointed that in a paper reviewing the organization of palliative care in rural areas there was no mention of the role of community hospitals.1 There are 470 community hospitals in the UK containing 18 500 beds. Although the bed configuration and medical cover of such hospitals varies, palliative and terminal care is a prominent role of these hospitals. The mean distance of these hospitals from a district general hospital is 14 miles,2 confirming the rural location. Where such hospitals exist, a lower rate of cancer deaths in district general hospital beds has been observed,3 with 70% of patients dying under the care of their GP (home, community hospital, nursing home and residential home).4 A case-matched study comparing community hospital cancer deaths with deaths in a hospice indicated comparable medical care and a high level of carer satisfaction with community hospital care.5,6 A Welsh study concluded that community hospitals might be an ideal setting in which to care for terminally ill people who do not require specialized hospice beds.7 Some drawbacks with community hospital care have been noted, such as lack of specialist trained nursing staff (compared with a hospice), problems with 24-h medical cover and quality of medical notes.5,6,8 A clearer view of some of these issues and the positive benefits of community hospitals for end of life care should be obtained when a multicentre study reports its findings (The National Research Register:ID:N0253111097). A Scottish working Party report confirmed the current and potential contribution of community hospitals to palliative care provision and made a number of helpful recommendations.9 Consequently any review of palliative care in rural areas should acknowledge the current contribution of community hospitals. Clearly the search terms employed in the review process were too limited and should remind all researchers to think laterally and not rely exclusively on modern literature search technology.