What is the evidence base for effectiveness and cost effectiveness of rapid response or enhanced response community palliative care service models?

Prys Thomas, Owain, Mann, Mala, Fielding, Helen, Croft, Rebecca and Byrne, Anthony 2021. What is the evidence base for effectiveness and cost effectiveness of rapid response or enhanced response community palliative care service models? [Working Paper]. Cardiff: Cardiff University.

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Abstract

The impact of COVID-19 has emphasized the need and increased the demand for specialist palliative care services. This has led to consideration of how to broaden the reach in delivering timely and responsive palliative care in the community. There is a recognition that palliative care services are supporting patients with increasingly complex needs and therefore, there is a necessity to adapt models of working accordingly. Gomes et al. 2013 showed that there is widespread evidence that over 50% of patients prefer to be cared for and die at home provided circumstances allow that choice. However, figures show that less than a third of patients in England and Wales achieve this with many ending up being admitted to hospital. The trigger for hospital admission is often multifactorial. These frequently consist of a combination of loss of symptom control, availability of medi-cine, carer health/stress and lack of clarity around prognosis/ expected disease trajectory, leading to a crisis that cannot be managed at home. In 2008, the Department of Health advocated provision of 24/7 services, using rapid response services (RRS) as one way to avoid unnecessary hospital admissions and in doing so enabling more pa-tients to die in the place of their choice (Department of Health: End of Life Care Strategy: Promoting high quality care for all adults at the end of life. London: Department of Health; 2008.). Achieving patient preference for place of death is increasingly used as a measurable indicator of the effectiveness of palliative care services. Services which can provide a rapid response to sudden changes in care needs have been described as one potential intervention of value, although the definition of ‘rapid’ and the nature of the service intervention may vary. For example, Gage et al. 2015 and Holdsworth et al. 2015 described a rapid response service (RRS) as a team of healthcare professionals who, within 4-hour notice, provided intense care over a short period of time when crises arose. This service was accessible 24/7 and aimed to support patients in their own place of care to help avoid admissions to the acute sector. King et al. 2000 stated that their RRS, comprising of a palliative care nurse respond-ing mostly within 4 hours, was developed to respond to people in crisis who would prefer to die at home. Clayton and Spencer, 2013 whose RRS comprised of a specialist palliative care nurse, did not clearly define “rapid re-sponse” but described optimizing symptom control and supporting end of life care in the patient’s preferred place of care as the main purpose for the RRS. Addicott and Dewar, 2008, demonstrated an increase in home-based deaths from 19 to 42% with the introduction of an RRS, whilst Clayton and Spencer 2013 stated 75% of their RRS patients achieved their preferred place of death whilst also suggesting it prevented unnecessary hospital admis-sions. Although the definition and configuration of an RRS differs between services, common themes include a timely response to a crisis led by trained professionals (nurses or healthcare support workers) who could provide hands on care, aiming to support the patient in their preferred place of care. Therefore, the rationale for this review is to explore existing evidence from prospective studies on the effect of a rapid response or enhanced response community palliative care model of service, using the key themes above within the definition of RRS. It aims to explore the effect on patient outcomes including achieving preferred place of death compared to existing services and whether there is any economic impact on the healthcare system. The data presented by King et al., 2000, Addicott and Dewar, 2008 and Clayton and Spencer, 2013 is not included in the key findings because these studies represent service evaluations and therefore did not meet the inclusion criteria.

Item Type:	Monograph (Working Paper)
Date Type:	Publication
Status:	Unpublished
Schools:	Medicine Academic & Student Support Service Marie Curie Palliative Care Research Centre (MCPCRC)
Uncontrolled Keywords:	rapid response, enhanced response, community palliative care
Additional Information:	Report uploaded to WCRC PaCERS website: https://walescancerresearchcentre.org/pacers/
Publisher:	Cardiff University
Funders:	Health and Care Research Wales through the Wales Cancer Research Centre
Date of First Compliant Deposit:	14 February 2023
Last Modified:	14 Feb 2023 12:15
URI:	https://orca.cardiff.ac.uk/id/eprint/156149

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