The delivery of palliative care

Abstract

Specialist palliative care services are now widespread throughout the U.K. There exist over 200 specialist inpatient hospices and many more palliative care teams in acute hospitals and in the community. Nearly all are headed by one or more doctors who are specialists in palliative medicine. However, such specialists are thinly spread and it is essential to ensure that there is wise use of this scarce and expensive resource. In an area of north-east England that has a completely integrated Specialist Palliative Care Unit (SPCU), giving an advisory service in acute hospitals and in the patients’ homes, as well as day hospice, inpatient hospice, research and education facilities, two aspects of the palliative specialist’s work were studied. Advisory visits to homes and the acute hospitals, which were done at the request of the specialist or the general practitioner, were studied for 3 months. Doctors, nurses, patients and relatives were questioned 1 week after the consultation, aiming to discover whether the visit had been prompt, helpful and effective. The palliative medicine specialist who made the visit was also asked whether the intervention had been effective, whether it had resulted in admission of the patient from home to hospice or hospital, and whether the visit had given him a better understanding of the patient’s physical, emotional and social needs. Secondly, a study was undertaken in a town where the clinical care of patients in the hospice is shared between the specialist in palliative medicine and the patient’s own family doctor. The family doctors were asked by means of a questionnaire how, after 4 years, they felt this was working, whether they favoured this shared care, whether they would prefer a change of staffing by full-time palliative medicine doctors, whether they would prefer to have total care of inpatients in the hospice without any consultant, whether their knowledge of palliative medicine had increased since the hospice opened, and whether their own practice in their care of other patients in their homes had changed.