Acceptability and perceived effectiveness of a district co-ordinating service for terminal care: implications for quality assurance.
As part of a randomized controlled trial of a new district co-ordinating service for the care of terminally ill cancer patients, the activities of the nurse co-ordinators and the acceptability and perceived effectiveness of the service were assessed. Co-ordinators' activities were self-recorded; professional caregivers completed a postal questionnaire; and family carers were interviewed at home. Thirty-eight per cent of patients allocated to the co-ordinators were not visited at home. Overall, 41% of professionals had heard of the co-ordinating service and 20% had been contacted. A third of relatives, whether allocated or not to the co-ordinating service, felt that terminal care of their patient was not well co-ordinated and that they did not know how to get the help they needed for their dying relative. It may be that the nurse co-ordinators were unwilling or unable to relinquish their skills in order to provide a 'broker' style of co-ordination. Perhaps less skilled co-ordinators would have been more successful. Moreover, the co-ordinating service had no budgetary responsibility. Those concerned with quality assurance in co-ordination of terminal care might consider the skill mix and professional training of the co-ordinators as well as their budgetary responsibilities and authority.
MacDonald
L D
LD
Department of Public Health Sciences, St George's Hospital Medical School, University of London, England.
Addington-Hall
J M
JM
Anderson
H R
HR
D017028:Caregivers / Q000523:psychology; D002391:Catchment Area, Health; D006801:Humans; D008131:London; D009369:Neoplasms / Q000451:nursing; D010347:Patient Care Planning / Q000458:organization & administration* / Q000592:standards; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care; D013727:Terminal Care / Q000458:organization & administration* / Q000592:standards