A realist evaluation of a “single point of contact” end-of-life care service
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 21 May 2020
Issue publication date: 9 June 2020
Abstract
Purpose
Following the development of a service that consisted of a “single point of contact” to coordinate end-of-life care (EoLC), including EoLC facilitators and an urgent response team, we aimed to explore whether the provision of coordinated EoLC would support patients being cared or dying in their preferred place and avoid unwanted hospital admissions.
Design/methodology/approach
Using a realist evaluation approach, the authors examined “what worked for whom, how, in what circumstances and why”. Multiple data were collected, including activity/performance indicators, observations of management meetings, documents, satisfaction survey and 30 interviews with service providers and users.
Findings
Advance care planning (ACP) increased through the first three years of the service (from 45% to 83%) and on average 74% of patients achieved preferred place of death. More than 70% of patients avoided an emergency or unplanned hospital admission in their last month of life. The mechanisms and context identified as driving forces of the service included: 7/7 single point of contact; coordinating services across providers; recruiting and developing the workforce; understanding and clarifying new roles; and managing expectations.
Research limitations/implications
This was a service evaluation and the outcomes are related to the specific context and mechanisms. However, findings can be transferable to similar settings.
Practical implications
“Single point of contact” services that offer coordinated EoLC can contribute in supporting people to be cared and die in their preferred place.
Originality/value
This paper provides an evaluation of a novel approach to EoLC and creates a set of hypotheses that could be further tested in similar services in the future.
Keywords
Acknowledgements
The authors would like to thank all the participants of this evaluation for sharing their experiences. The authors are also grateful for the support by the Connected Palliative Care staff members, Sandwell and West Birmingham Hospitals NHS Trust.Funding statement: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.Conflict of interest statement: The authors declare that they have no conflict of interests.
Citation
Efstathiou, N., Lock, A., Ahmed, S., Parkes, L., Davies, T. and Law, S. (2020), "A realist evaluation of a “single point of contact” end-of-life care service", Journal of Health Organization and Management, Vol. 34 No. 4, pp. 365-377. https://doi.org/10.1108/JHOM-07-2019-0218
Publisher
:Emerald Publishing Limited
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